More than Just a Brain Disorder: A Five-Point Manifesto for Psychological Care for People with Huntington’s Disease

Huntington’s disease (HD) is a rare and complex condition where affected individuals, family members, caregivers, and clinicians face a number of both long-term and fluctuating challenges. The predominant biomedical framework adopted in HD to date has traditionally viewed it as a brain disorder first and foremost. As a consequence, one of the most challenging aspects of the condition—psychological difficulties and their care—is often not given the emphasis it deserves in everyday clinical practice. Here, we propose a manifesto outlining five points to address the quality, effectiveness, availability, and accessibility of psychological care in HD. These include (1) Listening to People with HD, (2) Reformulating Difficulties Psychologically, (3) Exploring New Interventions, (4) Increasing Psychological Provision, and (5) Learning from Other Conditions. As the search for a cure continues, we hope that this manifesto will create a new impetus towards refining the current approach to psychological difficulties in HD and ultimately improve the quality of life of the tens of thousands of families affected by HD worldwide.

Pattern

Pattern is central in the pattern-focused case conceptualization approach. This chapter highlights the five basic treatment challenges for each of the eight common patterns in everyday clinical practice. It first defines pattern and provides a clinical strategy for quickly identifying and differentiating the basic patterns. Then, it describes eight patterns: avoidant, borderline, dependent, histrionic, narcissistic, obsessive–compulsive, paranoid, and passive–aggressive. Each of these patterns is discussed in the following format: pattern description, pattern development, pattern types and triggers, and treatment challenges. Clinicians who understand patterns and can identify them easily in clients are more likely to be able to explain and guide treatment, as well as anticipate treatment challenges.

Borderline and Depression: A Thin EEG Line

In everyday clinical practice, there is an ongoing debate about the nature of major depressive disorder (MDD) in patients with borderline personality disorder (BPD). The underlying research does not give us a clear distinction between those 2 entities, although depression is among the most frequent comorbid diagnosis in borderline personality patients. The notion that depression can be a distinct disorder but also a symptom in other psychopathologies led our team to try and delineate those 2 entities using 146 EEG recordings and machine learning. The utilized algorithms, developed solely for this purpose, could not differentiate those 2 entities, meaning that patients suffering from MDD did not have significantly different EEG in terms of patients diagnosed with MDD and BPD respecting the given data and methods used. By increasing the data set and the spatiotemporal specificity, one could have a more sensitive diagnostic approach when using EEG recordings. To our knowledge, this is the first study that used EEG recordings and advanced machine learning techniques and further confirmed the close interrelationship between those 2 entities.

Herpes-zoster-Update – was gibt es Neues?

Shingles are triggered by the reactivation of an infection with the varicella zoster virus (VZV) and are characterized by specific vesicular skin lesions. Mostly, elderly patients are affected. Depending on the affected dermatome, some serious complications can be observed. The introduction of a vaccine against shingles in Germany offers a great potential for reducing the frequency and severity of this disease. There are both a live vaccine, which is no longer recommended, and an inactivated vaccine, which, however, is still not sufficiently recommended to the authorized patient groups and is also only available to a limited extent due to delivery bottlenecks. HZ neuralgia is a serious complication of the disease that requires rapid and effective therapy and should be handed over to experienced pain therapists rather too early than too late. Unfortunately, in everyday clinical practice only a few people are familiar with VZV vasculopathy, which is associated with a significantly increased risk of cerebral insults.

Non-Invasive Continuous Measurement of Haemodynamic Parameters—Clinical Utility

The evaluation and monitoring of patients’ haemodynamic parameters are essential in everyday clinical practice. The application of continuous, non-invasive measurement methods is a relatively recent solution. CNAP, ClearSight and many other technologies have been introduced to the market. The use of these techniques for assessing patient eligibility before cardiac procedures, as well as for intraoperative monitoring is currently being widely investigated. Their numerous advantages, including the simplicity of application, time- and cost-effectiveness, and the limited risk of infection, could enforce their further development and potential utility. However, some limitations and contradictions should also be discussed. The aim of this paper is to briefly describe the new findings, give practical examples of the clinical utility of these methods, compare them with invasive techniques, and review the literature on this subject.

Nursing protocol: management of older and senile patients with pain syndrome

Pain syndrome in older patients requires a number of diagnostic and therapeutic measures that are not always performed in everyday clinical practice, especially in older patients. Regularly assessing of chronic pain and organizing adequate care measures is an essential task when older patients nursing. Nurses who are most in contact with patients can play a leading role in screening and ensuring timely corrections.