Krankenhaus Lübbecke-Rahden, Universitätsklinik für Psychosomatik und Psychotherapie

The cannabinoid hyperemesis syndrome (CHS) and the cyclic vomiting syndrome in adults (CVS) are both characterized by recurrent episodes of heavy nausea, vomiting and frequently abdominal pain. Both syndromes are barely known among physicians. Literature is inconsistent concerning clinical features which enable differentiation between CVS and CHS. We performed a literature review using the LIVIVO search portal for life sciences to develop a pragmatic approach towards these two syndromes. Our findings indicate that complete and persistent resolution of all symptoms of the disease following cannabis cessation is the only reliable criterion applicable to distinguish CHS from CVS. Psychiatric comorbidities (e.g. panic attacks, depression), history of migraine attacks and rapid gastric emptying may serve as supportive criteria for the diagnosis of CVS. Compulsive bathing behaviour, a clinical observation previously attributed only to CHS patients is equally present in CVS patients. Long-term follow-up is essential in order to clearly separate CHS from CVS. However, long-term follow-up of CVS and CHS cases is seldom. We provide a standard operating procedure applicable to a broad spectrum of health care facilities which addresses the major issues of CVS and CHS: awareness, diagnosis, treatment, and follow-up.

INTRODUCTION: This study was designed to investigate to what extent guidelines regarding the pharmacological treatment of patients suffering from schizophrenia-like psychosis are adopted in a naturalistic treatment setting. METHODS: Medical records of n=819 patients undergoing inpatient treatment for schizophrenia-like psychosis in 11 psychiatric hospitals in northwestern Germany were retrospectively analyzed and findings were compared to current schizophrenia guideline recommendations. RESULTS: The prescription rate of second generation antipsychotics increased from 47.1% on admission to 62.5% at discharge. Only half the patients (52.3%) received antipsychotic monotherapy while 47.7% took between 2 and 4 antipsychotic substances at a time. Dosage increases occurred most frequently (in 60%) within the first week of inpatient treatment, 16.6% experienced an elevation between days 15 and 29. A change within the atypical medication was found in 19.3%. Clozapine prescriptions increased throughout the treatment but were combined with other antipsychotic substances in the majority of cases. CONCLUSION: Under naturalistic conditions guideline recommendations for treatment of schizophrenia-like psychosis are adhered to only partially. Combination therapy with 2 or more antipsychotic drugs is quite common despite a clear recommendation for monotherapy.

This is an original manuscript of an article published by Taylor & Francis in Psychotherapy Researchon March 2024, available online (Open Access): https://doi.org/10.1080/10503307.2024.2320349.The original manuscript was revised and rewritten, please refer to the published article. Objective: To examine differential symptom-specific improvements across the therapies Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy (SP) in patients with persistent depressive disorder (PDD), incorporating interpersonal problems, and social functioning as potential mediators. Method: We conducted a three step Bayesian mediation network intervention analysis with data from a randomized controlled trial. Here, chronically depressed patients received either treatment with CBASP or SP. Three change score networks were calculated to investigate (1) differential symptom-specific improvements, (2) differential treatment effects on potential mediators, and (3) associations between change in symptoms and change in potential mediators. Results: There was no strong evidence for differential symptom-specific improvements across therapies. However, sleeping problems, self-esteem, and social functioning showed very small evidence for greater improvement with CBASP. Improvement in social functioning was associated with greater improvement in self-esteem and greater decrease in hopelessness with CBASP. “Interpersonal problems” and “impaired social functioning” were strongly related to each other and to depressive symptoms, which also were clearly associated with each other. Conclusion: The results suggest that changes in social functioning might mediate the associations between treatment with CBASP and specific symptoms. Future research needs to investigate potential mediators by testing postulated working mechanisms of therapies.