[Diagnostic Options for Suspected Cases of Emotional Maltreatment - Presentation of the Interdisciplinary Perspective of a Child Protection Outpatient Clinic]

Compared to sexual and physical violence, cases of emotional abuse are often more difficult to detect. An increasingly advocated approach involves regular assessments within social and healthcare structures tto proactively identify affected children and adolescents at an early stage. This enables the prompt initiation of appropriate interventions. Following, interdisciplinary institutions such as a child protection outpatient clinic can play an important role for professionals in the clarification of suspected child endangerment.This article aims to show possible courses of action for the early detection of emotional abuse based on a child protection outpatient clinic. In addition to the description of the interdisciplinary diagnostic procedure a selection of psychometric questionnaires and interviews is presented, which inquire about emotional abuse. When looking at the total number of 1,388 cases seen at the child protection outpatient clinic, it is noticeable that only 117 cases (8.4 %) were assigned with a suspicion of emotional abuse.This contrasts with 477 cases (34.3 %) in which confirmed indications for emotional abuse were found after the clarification process. An intersection of emotional abuse with other forms of child maltreatment was given in 341 cases (71.4 %). Psychometric questionnaires and interviews can facilitate a regular recording in health and social service institutions. Emotional abuse often goes unnoticed despite its frequency. Itsmanifestations are diverse and significantly overlap with other forms of maltreatment, necessitating a nuanced evaluation process. Specific diagnostic tools and interdisciplinary collaboration can contribute to better recognition of emotional abuse.

[Occurrence of canine subcutaneous dirofilariosis (Dirofilaria repens) in Switzerland]

INTRODUCTION

Infectious diseases are increasingly introduced into Switzerland due to the increased travel activity in recent decades and the import of dogs. Dirofilariasis, caused by Dirofilaria immitis or D. repens, is one of them. An infection with D. repens, the cause of canine subcutaneous dirofilariosis, is often asymptomatic in dogs, but represents a potential zoonotic disease risk for humans. Due to the rapidly increasing number of human cases, D. repens is considered an emerging zoonosis in north-eastern Europe. The prevalence of D. repens infections in dogs and humans in Switzerland is unknown. Since 2016 the analysing diagnostic laboratory provided with the newly introduced filaria PCR a realiable diagnostic test to differentiate betweeen D. immitis and D. repens. Total nucleic acid (DNA and RNA) was extracted from 200 μl EDTA blood without prior enrichment followed by a species-specific real-time PCR assay. The analyses for Dirofilariae in the years 2016 to 2021 were examined in a descriptive retrospective study and the proportion of positive tests per year (prevalence with 95 % confidence interval) was calculated. Furthermore, blood samples of 50 imported dogs to Switzerland were analyzed in an exploratory cross-sectional study for the presence of dirofilaria. No D. repens positive case was found in the first two years after the introduction of the PCR. In 2018 five of 546 analyzed samples (5/546, 0,9 %, 95 % confidence interval [95 % CI]=0,7 - 1,2 %) tested positive for D. repens, in 2019 four of 591 (0,7 %, 95 % CI=0,5 - 0,9 %), in 2020 15 of 783 (1,9 %, 95 % CI=1,6 - 2,3 %) and in 2021 eleven of 1058 samples (1,0 %, 95 % CI=0,8 - 1,3 %). In the exploratory cross-sectional study, four of the 50 examined dogs were positive for D. repens (8 %, 95 % CI=2,6 - 20,1 %). One dog had a concurrent infection with D. immitis and D. repens. All four positive tested dogs were imported from Hungary. Potentially zoonotic infections with D. repens occur in dogs living in Switzerland. This disease should be included in the differential diagnoses of imported dogs and a monitoring during routine health checks should be done more often. The veterinary profession can thus assume its responsibility for the prevention of zoonoses as part of a One Health approach.

[Equine anaplasmosis and equine piroplasmosis in Germany, Austria and Switzerland - previously anecdotal, now relevant?]

INTRODUCTION

Equine granulocytic anaplasmosis (EGA) and equine piroplasmosis (EP) are triggered by tick-borne pathogens - the intracellular bacterium Anaplasma phagocytophilum and the intracellular protozoa Babesia caballi and Theileria equi. These pathogens attack cells in the blood stream and cause similar clinical symptoms and changes in laboratory values. Although the treatment principles are naturally different, similarities in prophylaxis exists due to the transmission route. Tick transmitted pathogens can play a greater role in equine medicine in the future due to various factors, such as the tendency of relevant tick species to spread, but also the increasing import and travel activities of and with pets (both in the context of sporting events and as a leisure activity). While EGA is endemic in Central Europe, EP is a sporadic disease in Switzerland, Austria and Germany. However, EP must be viewed as underdiagnosed, as horses persistently infected with T. equi are also repeatedly detected in Central Europe. These diseases should be considered in horses with a fever and corresponding laboratory changes. Available diagnostic tests are direct pathogen detection by blood smear or PCR, and, indirect antibody detection, which is considered to be highly sensitive and (as a competitive ELISA) also very specific. Acute infections can be detected with PCR, serology is more suitable for chronic infections. A pathogen-free condition after treatment can be demonstrated with decreasing antibody titers in combination with repeated PCR tests. In addition, clinically healthy horses infected with T. equi should be identified by antibody detection and appropriate preventative transmission measures must be initiated. The prophylaxis of tick bites in horses is difficult due to the high exposure, and long-term tick bite prevention can hardly be guaranteed. Monitoring of tick activity and strict measures to prevent the spread of the pathogen within the tick population are therefore of great importance.

[Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]

Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics Abstract. Molecular cerebrospinal fluid (CSF) biomarkers of neurodegenerative diseases are now part of the established diagnostic tools for the clinical investigation of cognitive disorders in the elderly. Biomarkers allow for earlier and more accurate differential diagnosis, and are recommended by the Swiss Memory Clinics as an additional investigation based upon individual indication. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published recommendations. The results must be interpreted in the context of the other available history and assessment outcome. Thanks to recent research progress, blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice in the near future. This trend will likely lead to a much broader utilisation of biomarkers and may accelerate the development of effective and individually tailored prevention and treatment approaches. This review article provides an overview over the current state of biomarkers and provides the recommendations of the Swiss Memory Clinics for their use in clinical practice.

[Guideline S1: Long COVID: Diagnostics and treatment strategies]

This guideline comprises the state of science at the time of the editorial deadline. In view of the high turnover of knowledge the guideline is designed as a living guideline. The main objective was to provide a tool for the use in primary care, being considered well suited as a first point of entry and for the provision of care. The guideline gives recommendations on the differential diagnosis of symptoms following SARS-CoV‑2 infection, on their therapeutic options, as well as for guidance and care of the patients concerned. It also offers advice concerning return to daily life and rehabilitation. Long COVID being a very variable condition, we chose an interdisciplinary approach.

[Use of Standardized Symptom and Intelligence Tests at Socialpediatric Centres (SPZ) in Germany]

In German Socialpediatric Centres (Sozialpädiatrische Zentren, SPZ) children and adolescents with mental and physical disorders and disabilities are diagnosed and receive outpatient treatment. This cross-sectional study explores to what extent standardized symptom questionnaires and intelligence tests are applied in German Socialpediatric Centres. In Germany there exist 152 SPZ. One third participated in this questionnaire study (N = 50). Symptom questionnaires are applied by all participating SPZ (100 %), intelligence tests are used by 98 %. Among the most frequent used tests are intelligence tests ("Wechsler Intelligence Scale For Children (WISC)"; "Snijders-Oomen Nonverbale Intelligenztest" (SON-R5,5-17)) and tests assessing mental health symptoms ("Diagnostik-System für psychische Störungen (DISYPS-2)"; "Child Behavior Checklist-Elternfragebogen" (CBCL 4/18)). Specific mental disorders are assessed with a variety of different questionnaires. In our questionnaire 14 standardized symptom and intelligence tests were listed. The participating SPZ listed 110 additional symptom questionnaires that are used as well. Standardized symptom diagnostic at SPZ seems to focus on autism spectrum disorders, anxiety disorders, and depression. Implications for research and clinical practice are derived.

[Comparison between oral fluid samples and pooled serum samples for the detection of antibodies against Porcine Reproductive and Respiratory Syndrome Virus in weaning pig herds]

INTRODUCTION

Monitoring of Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) in pig farms is performed usually by testing for antibodies against PRRSV in serum samples. A new method is the detection of PRRSV antibodies in porcine saliva. In this study serum samples and saliva were collected in nine farms suspicious for PRRSV and tested for the presence of PRRSV antibodies. In total 220 serum and 41 saliva samples were taken from pigs at the age of 8 weeks (± 1 week). One saliva and one pooled serum sample (1:5) were tested from each pen. In total 11 (Cut-off 0.4/0.3) or 14 (Cut-off 0.2) serum samples and 23 saliva out of 41 pens were positive for PRRSV antibodies. Cohen`s Kappa testing showed a moderate agreement (κ = 0.446). Saliva samples compared to pooled serum samples were very sensitive, the specificity was 60 and 67, respectively.

[Psychotic disorders in ICD-11: the revisions]

Psychotic disorders in ICD-11: the revisions Abstract. This article provides an overview of the main changes to the chapter "Schizophrenia or Other Primary Psychotic Disorders" (6A2) from ICD-10 to ICD-11 and compares them with the psychosis chapter of DSM-5. These changes include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one must be a positive symptom) in the definition of "Schizophrenia" (6A20) and the allowance for bizarre contents in "Delusional Disorder" (6A24), which now includes "Induced Delusional Disorder" (F24). Further introduced are the focus on the current episode, the restriction of "Acute and Transient Psychotic Disorder" (6A23) to the former Polymorphic Disorder Without Schizophrenic Symptoms (F23.0), the diagnosis of delusional "Obsessive-Compulsive or Related Disorders" (6B2) exclusively as Obsessive-Compulsive Disorders, the specification of "Schizoaffective Disorder" (6A21), and the formulation of a distinct subchapter "Catatonia" (6A4) for the assessment of catatonic features in the context of several disorders. In analogy to DSM-5, ICD-11 now includes the optional category "Symptomatic Manifestations of Primary Psychotic Disorders" (6A25) for the dimensional quantification of symptoms. Again, developmental aspects remain unattended in in the ICD-11-definitions of psychotic disorders.

[Tuberculous Spondylitis - Diagnosis and Management]

Tuberculous Spondylitis - Diagnosis and Management Abstract. Despite a decreasing incidence of tuberculosis (TB) over the last decades in Switzerland, the frequency of newly diagnosed tuberculous spondylitis has remained stable. It occurs most frequently in old, immunocompromised persons and/or persons who have moved to Switzerland from TB endemic areas. It is a chronic manifestation of TB, which is characterized by 'cold abscesses', neurological deficits and kyphotic spinal deformity. Tuberculous spondylitis is often diagnosed with a delay, which can lead to higher morbidity and treatment complexity. Antibiotic therapy is essential in tuberculous spondylitis. Surgical interventions aim to obtain samples, decompress nervous structures, obtain pain control and, if necessary, deformity correction/stabilization. This paper provides an overview of the modern diagnostic and therapeutic management of tuberculous spondylitis in Switzerland.

[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

[Imaging for Non-Specific Low Back Pain According to 'Smarter Medicine' - a Survey from Three General Practices]

Imaging for Non-Specific Low Back Pain According to 'Smarter Medicine' - a Survey from Three General Practices Abstract. We examined how the recommendation of "smarter medicine"/Switzerland for diagnostic imaging of nonspecific lumbar back pain is implemented in three general practices.

METHOD

Retrospective analysis of 228 conventional X-ray images of the lumbar spine from three general practices.

RESULTS

Overall, about 75 % of the X-rays performed within six weeks after onset of pain were consistent with "smarter medicine" recommendations. Unsatisfactory pain improvement despite analgesics and/or physiotherapy was the most common reason for non-indicated (36.6 %), red flags [trauma (33.3 %), malignancy (19.5 %), osteoporosis (14.9 %)] for indicated (64.4 %) examinations. Per ten years of age, the probability of a non-indicated radiograph decreased by 20 % (p = 0.003).

CONCLUSION

Three out of four conventional X-ray images of the lumbar spine were performed according to the recommendations of "smarter medicine" in the three practices. The further promotion of 'smarter medicine' is crucial to avoid unnecessary diagnostic or therapeutic interventions and to save costs.

[Rare Forms of Mastitis]

Rare Forms of Mastitis Abstract. Inflammatory breast diseases caused by bacterial infections represent the main cause for mastitis in breastfeeding and non-breastfeeding women. The clinical appearance and a standardized evaluation can indicate rare inflammatory breast diseases. An underlying comorbidity or the evidence of rare pathogens could be suggestive. However, core needle biopsy is the main step in diagnostics. Malignancy, e.g. an inflammatory breast cancer must consistently be excluded. This mini review outlines a few rare inflammatory breast diseases, their initial presentation, and how to diagnose them accurately.

[The Role of Ultrasonography in Family Medicine]

The Role of Ultrasonography in Family Medicine Abstract. This overview describes the various applications of sonography in family practice. After an outline of the requirements for examiners and equipment, the individual areas of examination are discussed, in part with the most important diagnostic criteria, and illustrated with case studies using images and videos. Readers should be encouraged to make broad use of sonography and to attend regular further training and education courses in this field.

[Body Dysmorphic Disorder: Diagnosis, Treatment and Challenges in the General Practice]

Body Dysmorphic Disorder: Diagnosis, Treatment and Challenges in the General Practice Abstract. Body dysmorphic disorder (point prevalence: 1.7-2.4 %) is characterized by excessive preoccupation with one or more subjectively perceived blemishes of the appearance, as a result of which those affected show a high burden of disease due to avoidance behavior and time-consuming rituals, and often secondary problems (including depression, suicidal tendencies). The disorder is often accompanied by pronounced shame and is therefore associated with challenges in diagnostics, which is why the indication and specialist treatment (first-line treatment: cognitive-behavioural therapy) are usually only carried out with great latency. Family doctors can play a key role in diagnosis and treatment because of the often long-standing relationship of trust with their patients. Targeted screening, active and at the same time prudent discussion, as well as knowledge of treatment options and special features of the disease pattern (e.g. fluctuating understanding of the disease, desire for plastic surgery measures) are necessary. Against this background, the article provides an overview of the clinic, diagnostics and therapy and concludes with specific challenges and practical recommendations for family practice.

Diagnostic response to a cross-border challenge for the Swiss caprine arthritis encephalitis virus eradication program

INTRODUCTION

Animal trading between countries with different small ruminant lentivirus infectious status is a potential danger for the reintroduction of eradicated genotypes. This was the case in 2017 with the importation of a large flock of seropositive goats into Switzerland. The handling of this case permitted us to test the preventive measures in place. The coordination between the local veterinarian and the cantonal and federal veterinary authorities worked efficiently and rapidly involved the national reference center in the investigations. This case posed a challenge for the reference center and enabled scrutiny of the applied diagnostic tests. ELISA and western blot provided consistent results and pointed to an unusually high infection rate in the flock. This was confirmed by the isolation of several viruses from different organs and cells, demonstrating that the spleen is particularly well suited for isolation of small ruminant lentiviruses. The SU5-ELISA, designed to predict the subtype of the infecting virus, correctly pointed to a B1 subtype as the infectious agent. We confirmed that with this test it is necessary to analyze a representative number of samples from a flock and not just individual sera to obtain reliable results. This analysis permitted us to identify particular amino acid residues in the SU5 peptides that may be crucial in determining the subtype specificity of antibody binding. Different gag-pol and env regions were amplified by PCR using primers designed for this purpose. The phylogenetic analysis revealed a surprisingly high heterogeneity of the sequences, pointing to multiple infections within single animals and the entire flock. In conclusion, this case showed that the defense of the CAEV negative status of the Swiss goat population with respect to the virulent, prototypic B1 subtype of small ruminant lentiviruses, requires, among other measures, a diagnostic facility capable of performing a thorough analysis of the collected samples.

Der OPD-KJ2-SF – Ein Instrument zur Erfassung der Achse Struktur der OPD-KJ-2 bei Jugendlichen im Selbsturteil

Zusammenfassung. Die Erfassung der Strukturdimensionen nach OPD-KJ-2 ist neben ihrer therapeutischen Relevanz vor dem Hintergrund ihrer inhaltlichen Nähe zu gegenwärtig diskutierten dimensionalen Herangehensweisen in der Diagnostik von Persönlichkeitsstörungen im DSM-5 und in der ICD-11 von hoher Aktualität. Im Rahmen dieser Studie erfolgte eine Evaluation der psychometrischen Gütekriterien des neu entwickelten Fragenbogens OPD-KJ-2-SF zur Erfassung der Strukturdimensionen im Jugendalter. Die Untersuchung wurde anhand einer gemischten klinischen und nichtklinischen Stichprobe (N = 589) durchgeführt. Der OPD-KJ2-SF zeigte sehr gute psychometrische Kennwerte mit guten Skalenreliabilitäten von .87 bis .98 Cronbachs Alpha auf Gesamt- und Hauptskalenebene. Alle Hauptskalen diskriminierten hoch signifikant mit Effektstärken (d) von 1.4 bis 1.6 zwischen den Schüler_innen und Patient_innen mit Persönlichkeitsstörungen. Der OPD-KJ2-SF erscheint als ein reliables und valides Instrument zur Erfassung von strukturellen Beeinträchtigungen im Jugendalter.

[Child Protection in Families with Parental Mental Illness]

Child Protection in Families with Parental Mental Illness Children and adolescents from families with parental mental illness face an increased risk to experience abuse, neglect and maltreatment. The effects of imminent, intermittent or chronic distress on the development of the child and to differentiate these from neglect or maltreatment are not easily assignable in such families. Questionnaires and diagnostic instruments can be supportive tools for professionals in hospitals and private practices to identify and differentiate between burdens of children and families and potential endangerment. Different instruments are presented for the assessment of child abuse: For professionals the "Wahrnehmungsbogen für Kinderschutz" (Thurn et al., 2017). As methods of screening at risk the "Eltern-Belastungsbogen zur Kindeswohlgefährdung" (Deegener, Spangler, Körner, Becker, 2009) and the Childhood Trauma Questionnaire (Wingenfeld et al., 2010). For the comprehensive assessment of abuse, we present the Maternal Interview Child Maltreatment (Cicchetti, Toth, Manly, 2003). The prevalence of mentally ill parents is presented based on two samples of patients attending the child protection outpatient clinic or and the trauma outpatient clinic of the Charité. In the child protection outpatient clinic 15.8 % of the mothers and 11.4 % of the fathers fulfilled criteria for psychiatric disorders. In the trauma outpatient clinic we diagnosed a parental mental disorder in 20 % of all cases. A fictitious case report reveals the emotional maltreatment of a child by its mentally ill mother, which suffers from an isolated delusional disorder. Empirical based classification tools seem to be very appropriate to ascertain physical and sexual maltreatment and child neglect in children of parents with mental disorders, as permanent or severe neglect is frequently detectable in these families.

[Diagnostic procedure after abortions in sows after simultaneous infection with leptospira and chlamydia]

INTRODUCTION

In a farrowing farm 2 first parity sows aborted on day 95 and day 110 of gestation due to an infection with leptospira and chlamydia. The double infection was diagnosed by PCR examination of abortion material. Serum samples of both sows and additional 8 sows taken three weeks after abortions were sent to two different labs for serological examination for antibodies against leptospira and chlamydia using a microagglutination test and a complement fixation test, respectively. In both labs the tests for antibodies against chlamydia were negative. Titers against diverse leptospira serovars varied between both labs and were low, so that they were not indicative for the involvement of the two pathogens regarding abortion. This case report indicates the diagnostic difficulties of direct and indirect detection methods for leptospira and chlamydia to assess the impact of these pathogens on observed reproductive failure.

[Clinical diagnostics of psycho-social and cognitive standard of performance in youth with mental disabilities.]

Clinical diagnostics of psycho-social and cognitive standard of performance in youth with mental disabilities. Abstract. The clinical diagnostics of cognitive limitations and the resulting problems of social development occurring in childhood and adolescence are essential for further stimulation as well as for possible treatment strategies for comorbid mental diseases. This complex process should be carried out on several levels and with different methods. The resulting praxis-oriented question is defined via the pros and cons of the current procedure for the recording of psycho-social and cognitive stage of development of young people with mental disabilities. The online-based research in relevant databases was conducted systematically and yielded 3,324 articles. After fully reviewing the disqualifying criteria, 30 procedures remained. Twenty-four procedures could be assigned to "tests of development and intelligence" and six to "observer rating and self-report methods". It becomes clear that the majority of treatments have been standardized for children and adolescents of average intelligence. Meaning, only inaccurate information regarding the participation of children and adolescents with intelligence impairments in the standardized sample were given. This goes hand in hand with qualifying criteria that were not tested in consideration of the needs of people with intelligence impairment. Despite the current unsatisfactory situation, there is a demand for diagnostic instruments of the psycho-social and cognitive standard of performance in youth with mental disabilities. Currently, K-ABC II and ADOS-2 are recommended in combination with the observer rating methods ADI-R, VFE, and SRS.

Disruptive Behaviors across Different Disorders: Evaluation of a Clinical Sample Using the Eyberg Child Behavior Inventory

OBJECTIVE

The study reports the prevalence of disruptive behaviors in a help-seeking sample of young children across a diverse range of clinical diagnoses (based on ICD-10).

METHOD

The Eyberg Child Behavior Inventory (ECBI), a parent rating scale of disruptive behaviors, was completed on 310 children (2-11 years) at three child and adolescent psychiatry clinics in three German states (Bavaria, Hesse, Lower Saxony); the majority of children were outpatients.

RESULTS

Mean intensity scores of disruptive behaviors differed significantly by diagnostic group, with the lowest ratings within a community sample, and increasingly higher scores in children with a diagnosis from the internalizing spectrum, those with pervasive developmental disorders, and finally, those with externalizing disorders (e. g. hyperkinetic disorder, conduct disorders). Seventy percent of the clinical sample, compared to only 17 % of the community sample, exceeded the normative cut-off score of 111, indicating that disruptive behaviors are common in young German children seeking help for different mental health problems.

CONCLUSIONS

These findings support the Research Domain Criteria approach by showing that disruptive behaviors cross our current diagnostic labels and may need to be assessed and conceptualized in treatment planning, even in children without a primary diagnosis from the externalizing spectrum.

[Perspectives for the Electroencephalogram in Psychiatry]

Perspectives for the Electroencephalogram in Psychiatry Abstract. The electroencephalogram (EEG) is a non-invasive and cost-effective method to monitor spontaneous neuronal activity over time. Pathologies in EEG recordings indicate with high sensitivity but low specificity abnormal functional brain states. The main psychiatric indications for EEG recordings include atypical clinical symptoms of a neuropsychiatric syndrome or atypical reactions to medication as well as a baseline diagnostic before starting treatment with specific drugs or stimulation modalities. In recent research the EEG continues to be a valuable tool not only in diagnostics but also for the prediction of treatment success. The following paper focuses on basic electrophysiological understanding of EEG recordings, the diagnostic value of EEG recordings in different clinical entities, and new research attempts in diagnostic and treatment prediction.

[CME: Rabies Update: Symptoms, Diagnostics and Therapy]

Rabies is one of the oldest known infectious diseases and certainly one of the most feared because of its impressive course. Despite continuous improvement in medical treatment, the disease continues to be almost always fatal after onset of symptoms. Due to urbanization, rabies has lately somewhat disappeared from the public focus in Central Europe. Because of the remaining high number of fatal cases due to rabies infection worldwide and the persistent risk of contagion on holiday or within Switzerland, e.g. due to illegal import of infected animals, the disease is becoming a frequent topic in the media again.

[Not Available]

Zusammenfassung. Gallensteine finden sich bei 10–20 % unserer Bevölkerung, und jährlich werden in der Schweiz gegen 15 000 Cholezystektomien durchgeführt. Grundsätzlich muss zwischen der Cholezystolithiasis (Gallenblasensteine) und der Choledocholithiasis (Gallengangsteine) unterschieden werden. Während der überwiegende Teil der Patienten mit (inzidentellen) Gallenblasensteinen lebenslang keine Beschwerden erleidet, können Gallengangsteine schwerwiegende Komplikationen (z.B. Cholangitis, Pankreatitis) verursachen. Laborchemisch erhöhte Transaminasen und Cholestaseparameter sind bei einer Cholezystolithiasis selten und müssen (bei passender, biliärer Klinik) an eine Choledocholithiasis denken lassen. Bildgebend kommt im Falle von biliären Symptomen primär eine abdominale Sonografie, bei Verdacht auf eine Choledocholithiasis allenfalls zusätzlich eine MRC (Magnetresonanzcholangiografie) oder EUS (Endosonografie) zum Einsatz. Therapie der Wahl bei symptomatischer Cholezystolithiasis sowie nach biliären Komplikationen ist die laparoskopische Cholezystektomie, während Gallengangsteine meist anlässlich einer ERC (endoskopisch retrograde Cholangiografie) mit Papillotomie entfernt werden können.

[Not Available]

Zusammenfassung. Zusammenfassung: Akute und chronische Infektionen sind eine gefürchtete Komplikation nach Implantation einer Gelenkprothese und sind schwierig zu diagnostizieren. Grund dafür ist der Biofilm-Modus des Bakteriums. Mikrobiologische Kulturen zur Bestimmung der Mikroorganismen können negativ bleiben, sodass Zusatzuntersuchungen wie eine Gelenkpunktion mit Bestimmung der Leukozyten oder die histologische Aufarbeitung des Gewebes wichtig sind. Zur besseren Sensitivität sollten mehrere Gewebeproben intraoperativ aus Arealen mit vermutlich hoher Keimdichte (Interphasenmembranen, Kapsel) abgenommen werden. Neuere Biomarker wie alpha-Defensin zur Diagnose eines periprothetischen Infektes oder der molekulargenetische Diagnostik (Multiplex-PCR) zur Bestimmung des auslösenden Pathogens gehören noch nicht zur Standarddiagnostik. Die folgende Arbeit fasst die Wertigkeit und Limiten der verschiedenen Diagnostikmöglichkeiten zusammen.

[Accessing Disturbances of Attachment Symptoms Using Interview Technique]

Disturbances of attachment represent a clinically significant disorder and seriously impair social behavioural functioning. To date there has been little research and valid diagnostic methods are lacking. In the present study a German Version of the Disturbances of Attachment Interview developed by Smyke and Zeanah (1999) was used to assess disturbances of attachment in a sample of foster children and the validity of the translation is investigated. Furthermore, the Strengths and Difficulties Questionnaire (Goodman, 1997) was used to examine the discriminative validity. The results show a satisfying reliability and the scales of attachment disorders declare the main of the variance. There is a weak association between the disinhibited scale and hyperactivity in the SDQ. Overall the disinhibited disorder can be distinguished from other behaviour patterns. Regarding the inhibited scale there are associations with all SDQ scales and the inhibited category seems harder to distinguish from other deviant developmental issues. The method is evaluated as a qualified approach to the diagnosis of attachment disorders in the context of a multimethodical approach. Furthermore, the findings suggest further examination of the construct of attachment disturbances.

[Attachment and Adoption: Diagnostics, Psychopathology, and Therapy]

This presentation describes the development of attachment between adopted children and their adoptive parents with a focus on the particular issues seen in international adoptions. The questions of settling in, trauma in the country of origin, and the motivations of the adoptive parents will be discussed. Diagnosis and various psychopathological manifestations will be examined, as will outpatient and inpatient modes of therapy. The treatment of children of various ages will be covered along with the necessity for intensive counseling and psychotherapy for the adoptive parents. This will enable the parents to work through early trauma, which will give them and their adopted child the basis for developing healthy attachment patterns. This in turn will enable the child to mature and integrate into society. Possibilities of prevention are discussed. Many of the approaches discussed here regarding attachment and adoption may be applied to foster children and their foster parents.

[The methodological assessment and qualitative evaluation of psychometric performance tests based on the example of modern tests that assess reading and spelling skills]

This article looks at a means of objectively evaluating the quality of psychometric tests. This approach enables users to evaluate psychometric tests based on their methodological characteristics, in order to decide which instrument should be used. Reading and spelling assessment tools serve as examples. The paper also provides a review of German psychometric tests for the assessment of reading and spelling skills. This method facilitates the identification of psychometric tests.of high methodological quality which can be used for the assessment of reading and spelling skills. Reading performance should ideally be assessed with the following instruments: ELFE 1-6, LGVT 6-12, LESEN 6-7, LESEN 8-9, or WLLP-R. The tests to be used for the evaluation of spelling skills are DERET 1-2+, DERET 3-4+, WRT 1+, WRT 2+, WRT 3+, WRT 4+ or HSP 1-10.

[Screening interview for early detection of high-functioning autism spectrum disorders]

OBJECTIVE

Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities.

METHOD

The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ > 70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD.

RESULTS

The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74.

CONCLUSION

The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.

[The AWMF-Guidelines for Hyperkinetic Disorders in therapeutic practice- knowledge, familiarity, utilization, and attitude of psychotherapists and physicians]

OBJECTIVE

The AWMF-Guidelines for Hyperkinetic Disorders (ADHD) provide psychotherapists and physicians with guidance concerning diagnostics and treatment for one of the most common disorders in children and adolescents. To date, however, it is unclear how these guidelines are being applied by practicing therapists (both physicians and psychotherapists) and what they consider to be its pros and cons. This study proposes (1) to analyze the differences between the estimation of ADHD-guidelines by users and nonusers, their corresponding attitudes, experiences, and evaluations of context factors; and (2) to analyze whether users and nonusers differ in their therapeutic practice.

METHODS

71 therapists participated in a nonrepresentative online survey.

RESULTS

The hypothesis was confirmed that, on average, users had a more positive attitude toward and experience with guideline-driven treatment than did nonusers. The results also show a small positive effect of guideline use on treatment quality. However, the methods employed by users and nonusers only moderately corresponded with the recommendations of the guidelines.

CONCLUSIONS

It was shown that the ADHD guideline is only rarely being used, even under advantageous conditions, and that a practice-oriented form of the guideline does not exist until now.

[Development of PCR methods for detection of EAV infection]

The goal of this work was the development of suitable (real-time) RT-PCR techniques for fast and sensitive diagnosis of EAV and for molecular-epidemiological characterisation of viral strains, as an alternative to virus isolation. To this purpose two conventional RT-PCR methods and one real-time RT-PCR were adapted to detect the broadest possible spectrum of viral strains. Several dilutions with Bucyrus strain showed a 100-fold higher sensitivity of real-time RT-PCR and heminested RT-PCR compared to simple RT-PCR. Making use of 11 cell culture supernatants of different EAV isolates and 7 semen samples of positive stallions, the suitability of the techniques could be shown. Phylogenetic analysis of sequences of the newly analysed samples compared with known sequences indicated that more EAV-lineages exist than presently described.

[Specific learning disabilities - from DSM-IV to DSM-5]

The publication of the DSM-5 means changes in the classification and recommendations for diagnosis of specific learning disabilities. Dyslexia and dyscalculia have been reintroduced into the DSM. Three specific learning disorders - impairment in reading, impairment in the written expression, and impairment in mathematics, described by subskills - are now part of the DSM-5. Three subcomponents of the reading disorder are expressly differentiated: word reading accuracy, reading rate, and fluency and reading comprehension. Impaired subskills of the specific learning disorder with impairment in written expression are spelling accuracy, grammar and punctuation accuracy, and clarity and organization of written expression. Four subskills are found in the mathematics disorder: number sense, memorization of arithmetic facts, accurate or fluent calculation, and accurate math reasoning. Each impaired academic domain and subskill should be recorded. A description of the severity degree was also included. The diagnosis is based on a variety of methods, including medical history, clinical interview, school report, teacher evaluation, rating scales, and psychometric tests. The IQ discrepancy criterion was abandoned, though that of age or class discrepancy criterion was retained. The application of a discrepancy is recommended by 1 to 2.5 SD. All three specific developmental disorders are common (prevalence 5 %-15 %), occur early during the first years of formal schooling, and persist into adulthood.

[The dimensional-categorical hybrid model of personality disorders in DSM-5 from an adolescent psychiatric perspective - criticism and critical outlook]

By applying the dimensional-categorical hybrid model, Chapter III of the DSM-5 proposes a central innovation in the classification of personality disorders, the aim being a reduction of comorbidity and improvement of the construct as well as the discremental validity and stability of the diagnosis. The well-known categorical classification of personality disorders in Chapter II, however, remains valid. Based on the hybrid model the essential aspects of a personality disorders are as follows: the dimensional assessment of levels of personality functioning regarding disturbances in self (identity and self-direction) and interpersonal (empathy and intimacy) aspects on the one hand, and the existence of pathological personality traits on the other. Beside five higher-order traits, 25 specific trait facets are described. Moreover, a reduction in the number of personality disorder types is proposed, reflecting six instead of ten categories which are empirically best validated. The abandoned age limitation for the assessment of a personality disorder in Chapter III can be regarded as a clear statement with respect to the possibility and necessity of diagnosing and treating personality pathology in adolescence. By presenting an additional dimensional approach with a detailed description of personality functioning as well as specific pathological personality traits, the new hybrid model seems to principally be a useful approach for clinical purposes as well as research questions.

[Comparison of management of ambulatory emergency patients in the family practice and the hospital emergency center]

The increase in health care cost is broadly discussed in the public, either in the hospital or ambulatory setting. With the present study we compared the invoice amount generated by a first doctor's advice in the general practitioner to the one in the emergency room. In addition, we compared the diagnostic procedures used in the general practice to the one in the hospital, and whether the choice of diagnostic procedures would substantially influence the invoice amount. The invoice amount in the hospital setting was on average CHF 197.-, i. e. 134%, higher compared to the general practice. The difference in the invoice amount was largely explained by more diagnostic procedures in the hospital. Moreover, part of the higher invoice amount was generated by the extensive physical examination by doctors in the hospital.

[Diagnosis, therapy and prevention of respiratory virus infections in lung transplant recipients]

Lung transplant recipients have a life-long profound immunosuppression which makes them prone to respiratory tract infections, in particular viral infections during the winter season. Since the respiratory tract infections may have potentially severe consequences, we recommend early diagnosis and treatment. We obtain nasopharyngeal swabs for viral and bacteriological examination and then treat pre-emptively with antivirals, broad-band antibiotics and often also with intravenous immunoglobulins. Treatment duration is often longer than in immunocompetent patients. As preventive measures we provide vaccination against seasonal influenza and recommend specific daily hygiene measures.

[Knee pain of unknown origin after total knee prosthesis in a patient with chronic polyarthritis]

Persisting pain after TKA is a frequent problem. The most frequent differential diagnoses are aseptic loosening, malpositioning or a prosthetic joint infection. Retropatellar pain, functional or psychosomatic cause should be taken into account, too. An acute episode in patients with a rheumatoid arthritis should be ruled out. Insufficiency fractures, which can also be found in the presented case, are more often in patients with rheumatoid arthritis. The insufficiency fracture was detectable in the MRI and shows an uncommon, non-described localization. To prevent a loss of mobility of fractures close to the joint a surgical stabilizing is recommended, leading to quick healing.