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Background: Obsessive-compulsive disorders (OCD) are mainly treated with disorder-specific cognitive behavioral therapy using exposure and response management and/or selective serotonin reuptake inhibitors; however, a significant subgroup of patients does not sufficiently benefit from this approach., Objective: This article provides an overview of treatment-resistant OCD., Material and Methods: In this narrative review the definition, causes, diagnostic and therapeutic approaches to treatment-resistant OCD are addressed., Results: Treatment resistance can be assumed in the absence of clinically relevant improvement under therapy, in the sense of a reduction of < 25% on the Yale-Brown obsessive-compulsive scale and a score of 4 (no change) on the clinical global impression-improvement scale. The number of unsuccessful treatment attempts required to establish treatment resistance is defined differently. Causative factors include misdiagnosis, a high severity, comorbid disorders, substance use, specific symptom constellations, organic causes, environmental factors, and aggravating factors in psychotherapy and pharmacotherapy. Suggestions for diagnostic and therapeutic approaches based on the German S3 guideline on OCD are presented., Conclusion: For patients with treatment resistance to first-line therapy, useful diagnostic and therapeutic recommendations are available (psychotherapeutic, psychopharmacological and neurostimulation procedures)., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In 2022, the first revised version of the S3 guidelines on obsessive-compulsive disorder will be published under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). This article contains a summary of the most important recommendations for therapy in a condensed form. There were no major changes in the central basic therapy recommendations compared with the first version of the guidelines, as the evidence base has not fundamentally changed since then. Cognitive behavioral therapy (CBT) with exposure and response management is the most effective form of therapy for this clinical picture and therefore the therapy of first choice. Regarding pharmacotherapy, selective serotonin reuptake inhibitors are the first-line medications. They are indicated when CBT with exposure is not available or has not been effective, when CBT is rejected by the patient and in the patient's personal preference for medication, or to increase the readiness for CBT with exposure. New recommendations include, e.g., the use of Internet therapy, and recommendations for the use of CBT and exposure, e.g., also in group format, including video conferencing if appropriate as well as in intensive format., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Anorexia nervosa is a common psychiatric disorder in adolescents and young adults and is often associated with high rates of comorbidities and a chronic course of the disease. Additionally, it still shows the highest rates of mortality among all psychiatric disorders. The case presented describes a female patient with severe and enduring anorexia nervosa who achieved remission after strict adherence to inpatient treatment and showed a full recovery in the 3‑year follow-up. Shortly after achieving a minimum weight of 25 kg (171 cm, body mass index 8.5 kg/m 2 ) the 21-year-old, chronically ill patient was admitted to an intensive care unit. After a phase of stabilization and achieving a BMI of 10 kg/m 2 , she was transferred to a hospital specialized in treating eating disorders. It came to a full recovery of the patient including full weight restoration during regular follow-ups (BMI 20.0 kg/m 2 ) and normalization of the psychopathology of the eating disorder. In a 3-year follow-up, the patient presented with an enduring and complete remission of all symptoms, which were extremely expressed during the illness.

Eating disorders are a common mental disorder during adolescence and young adulthood. While prevalence rates of eating disorders dramatically increased during the second half of the last century, these rates have remained relatively stable over the last 20 years. According to ICD-10 eating disorders are diagnostically categorized as anorexia nervosa, bulimia nervosa and atypical eating disorders or eating disorders not otherwise specified. Concerning the etiology, genetic factors are involved, especially in anorexia nervosa, as well as psychological and sociocultural factors. Evidence-based recommendations are available for the treatment of bulimia nervosa and binge eating disorder and in this context cognitive behavioral therapy is seen as the first choice. In contrast, the state of knowledge concerning the treatment of anorexia nervosa is still limited, especially concerning effective treatments for adults. Recent data only provide evidence for the effectiveness of family therapy for adolescents. Due to the lack of high quality studies, research on therapy for anorexia nervosa is a future challenge.

Recent technological developments of communication media offer new approaches to diagnostic and therapeutic interactions with patients. One major development is Internet-based primary prevention in vulnerable individuals not yet suffering as well as the development of new therapeutic approaches for affected individuals based on the experiences of guided self-help through CD, DVD or bibliotherapy. The eating disorder literature shows several interesting, partly controlled and randomized, studies on bulimia nervosa, a few studies on binge eating disorder and no studies on anorexia nervosa. As part of the German Eating Disorder Network on Psychotherapy (EDNET) a 9-month Internet-based relapse prevention program for patients with anorexia nervosa after inpatient treatment was evaluated. Conception, first experiences and first results of the Internet-based relapse prevention program for anorexia nervosa are reported.

Obsessive-compulsive disorders are with a 12-month prevalence of up to 1% and a lifetime prevalence of 1-2% among the more common mental disorders. This is, however, neither reflected in the health care utilization of patients nor in the daily practice of psychotherapists, where obsessive-compulsive disorders still do not seem to play a major role. Due to feelings of shame, patients often tend to conceal their obsessive-compulsive symptoms. Furthermore, besides deficits in the health care situation for this disorder, treatment practice is not satisfying as well. Current guidelines recommend exposure and response prevention as the psychotherapeutic intervention of choice. Although this treatment has proved to be effective, it is still underutilized in psychotherapeutic routine care.Lack of experience or training on the part of therapists as well as insufficient information about the disorder and treatment possibilities on the part of patients contribute to the existing insufficient and inappropriate health care situation. Further education for therapists as well as more information for patients may help to sensitize them to this disorder and therefore increase the prognosis considerably.

Obsessive-compulsive disorder is a severe, very disabling condition that usually takes a chronic course if no adequate treatment is applied. Up to now, cognitive behavioural therapy with exposure and response prevention (CBT) is the most thoroughly investigated and most effective intervention, leading to a clinically significant symptom reduction in 60-70% of the patients. Correctly applied, this treatment can be equally effective as its combination with pharmacological management. For a correct implementation, however, several points have to be considered which are described in the following review. Considering the fact that some of the patients are unable to benefit sufficiently from this approach, potential alternatives and extensions of CBT are discussed. To date, however, no other treatment approach has proven to be effective based on randomised controlled trials.

The classic criticism levelled at German medical studies was addressed in 2002 with the reform of the German medical accreditation system. For the specialties Psychiatry and Psychotherapy, a national workshop of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) was held in Heidelberg on 23.01.2004 to implement the new legal requirements for teaching. In 2008, a postal survey was conducted among the 36 German medical faculties by the DGPPN to establish the current status of the proposed implementation, with the general structure of undergraduate medical training, student-centered syllabuses and the general significance of teaching forming the main points. With a response rate of 75%, the results can be considered representative. In general, a cautiously positive conclusion can be drawn on the implementation of the medical accreditation system. Having said that, it should be borne in mind that implementation is not yet complete and still requires optimization, for example in terms of making examinations not only theoretical but also more practical in approach.

Slow-wave sleep is defined as sleep stages 3 and 4 that characteristically show slow delta EEG activity during polysomnography. The percentage of slow-wave sleep normally declines with age. Sleep disorders are a common symptom of many psychiatric disorders. In polysomnographic recordings they mostly manifest as disturbances of sleep continuity. In some disorders changes in REM sleep are also found. A reduction of slow-wave sleep has most often been described in patients with depression and addictive disorders. More recent research implicates slow-wave sleep as an important factor in memory consolidation, especially the contents of declarative memory. Psychotropic drugs influence sleep in different ways. Hypnotic substances can reduce the deep sleep stages (e.g. benzodiazepines), whereas 5-HT2C antagonists increase the percentage of slow-wave sleep. Whether a selective impairment/alteration of slow-wave sleep is clinically relevant has not yet been proved.

Because of the new medical licensure act in Germany, much more bedside teaching than before is needed. For many of the relevant clinical pictures, few patients can be expected to undergo study lessons. That is why many universities use simulated patients (SP). In contrast to other disciplines such as internal medicine or surgery, there is not much literature about SP in psychiatry and psychotherapy. The objective of this pilot study was to evaluate if SP used for clinical teaching in addition to real patients are well accepted for simulation of psychiatric illnesses and clinical teaching. After randomization, one half of the 139 study medical students were taught using real patients and the other half using real patients and SP. The amounts of patient contact were equal in both groups. Using a questionnaire, pre- and postanalysis was carried out of answers about communication skills, the capability of addressing difficult subjects such as suicidality, and interest in psychiatry. The acceptance rate of SP was very high. Students' ratings of clinical teaching and their own performance, and their interest in future psychiatric work were significantly higher in the SP group. The results of this pilot study are very encouraging and indicate that the systematic use of SP in clinical psychiatric teaching is not only an appropriate alternative to real patients but also can lead to higher quality.

Over the last few years, a shift in paradigm has taken place in the diagnosis and therapy of insomnia. Traditionally, treatment focused on improving night sleep, i.e. shortening sleep latency and prolonging total sleep time. Modern approaches aim at improving or restoring the recuperative value of sleep and ensuring daytime functioning on a social, psychological and professional level. Based on the guidelines "Non-restorative Sleep" of the German Society of Sleep Research and Sleep Medicine, this article presents a clinical algorithm for the diagnosis and therapy of non-restorative sleep with predominant insomnia. The term "non-restorative sleep" permits us to view the restorative value of sleep and the resulting daytime functioning of the individual afflicted with insomnia as the focus for the diagnosis of and therapy for insomnia. This algorithm is suitable for the clinical practice of outpatient psychiatric and psychotherapeutic services as well as for psychiatric inpatients. The main features for psychiatrists and psychotherapists in the diagnosis and therapy of non-restorative sleep are underlying psychiatric-psychological factors or secondary psychiatric sequelae of chronic primary insomnias. For primary, organic and psychiatric insomnias, a broad spectrum of psychopharmacological and cognitive behavioral methods can be applied either alone or in combination.

Forty-eight-hour rapid cycling is a rare subclass of affective disorders and entails a regular periodic change of moods. The following case study describes the symptoms, therapy, and outcome of a patient suffering from daily switching between mania and depression along with neurobiological findings correlated to the affective cycles. We found alternating reduction and prolongation of sleep duration during manic and depressive days as well as differences in the amount of REM sleep. Cortisol secretion was regularly increased during depressive days. Regarding thyroid-stimulating hormone (TSH) secretion, the circadian rhythm was absent on depressive days. However, the glucose metabolic rate as measured by positron emission tomography (PET) did not differ on manic and depressive days. The patient reached almost complete remission under treatment with lithium.

This is a report of one of the few cases of an adult form of metachromatic leukodystrophy with almost exclusively psychiatric symptoms. This should point out the importance of a careful organic diagnostic assessment in all patients with the first manifestation of a psychiatric disease. In this case an investigation of the patient's family confirmed the heterozygote genetic origin of the disease.