Fortschritte der Neurologie-Psychiatrie
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Fortschr Neurol Psychiatr · Jan 2021
[The Two Sources of Meaning: A Critique of the Psychiatric Hermeneutic in Reference to Schleiermacher].
Psychiatric hermeneutic considers only the subjective meaning and thereby ignores an entire dimension of meaning, the so called 'grammatical meaning', a term coined by Schleiermacher, which is generated autonomously, according to the rules of language and sociality. ⋯ If meaning is understood as a product that is created step by step in a process of interaction, the perspective and consequently the conventional notions change profoundly: Meaning is then generated between the interactants, not in them, neither in their psyche nor their brain.Only a conceptualization that makes the medium of language and sociality the first object of understanding in its own lawfulness can enable an understanding of what it is that we actually understand while understanding: meaning - as the way in which a subject reproduces itself in the medium of language and sociality.
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Fortschr Neurol Psychiatr · Nov 2020
Die "Präzisionspsychiatrie" muss Teil der "personalisierten Psychiatrie" werden.
'Precision medicine' is defined as 'an emerging approach for treatment and prevention that takes into account each person's variability in genes, environment, and lifestyle'. Sometimes the term 'personalized medicine' is also used, either as a synonym or in a broader sense. In psychiatry, the term 'personalized' applies to different levels of health-care provision, such as the service organization and the choice of treatment plans based on the characterization of the individual patient. ⋯ This article provides an overview of recent advances in neuroimaging, multi-omics and computational neuroscience, which have contributed to foster our understanding of the neurobiology of major mental disorders, and led to the implementation of a precision medicine-oriented approach in psychiatry. We argue that, while 'precision psychiatry' represents an important step to further advance the effectiveness of the 'personalized psychiatry', the distinction between the two terms is important to avoid dangerous neglect of the current potential of personalized care in psychiatry and to underscore the need for disseminating good existing practices aimed at organizing mental health services and providing care according to person's psychopathological characteristics, illness trajectory, needs, environment and preferences. In conclusion, 'precision psychiatry' will contribute to advance 'personalized psychiatry', but for the time being keeping the distinction between the two terms will contribute to fully exploit the current potential of personalized care.
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Fortschr Neurol Psychiatr · Nov 2020
'Precision' or 'personalized' psychiatry: different terms - same content?
Due to the increased lifetime prevalence and personal, social, and economic burden of mental disorders, psychiatry is in need of a significant change in several aspects of its clinical and research approaches. Over the last few decades, the development of personalized / precision medicine in psychiatry focusing on tailored therapies that fit each patient's unique individual, physiological, and genetic profile has not achieved the same results as those obtained in other branches, such as oncology. The long-awaited revolution has not yet surfaced. ⋯ Since then, the co-existence of the two terms has sparked a great deal of discussion around the definition and differentiation between the two types of psychiatry, as they often seem similar or even superimposable. Generally, the two terminologies are used indiscriminately, alternatively, and / or separately, within the same scientific works. In this paper, an overview is provided on the overlap between the application and meaning of the terms 'precision psychiatry' and 'personalized psychiatry'.
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Fortschr Neurol Psychiatr · Sep 2020
Review[Genetic testing for Parkinson's disease: indication and practical implementation].
More than 20 years have passed since the first description of a monogenic cause of Parkinson's disease. Despite the tremendous advances of genetic testing these techniques are rarely used in Parkinson's disease. ⋯ This is not only to ensure the diagnosis of Parkinson's patients with a young onset and / or a positive family history, but also in the context of personalised medicine with new therapeutic options. In the following we would like to give an overview of the basics of genetic testing, the legal requirements, the procedure for genetic testing and an outlook into the future for hereditary Parkinson's diseases.
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Fortschr Neurol Psychiatr · Sep 2018
Review[Spinal muscular atrophy - clinical spectrum and therapy].
Spinal muscular atrophy (SMA) is a progressive autosomal recessive motor neuron disease with an incidence of 1:10,000 live births, caused by loss of the survival motor neuron 1 gene (SMN1), and represents the most frequent neurodegenerative disorder in children. With greater understanding of the molecular basis of SMA in the past two decades, a major focus of therapeutic developments has been on increasing the fulllength SMN protein by increasing the inclusion of exon 7 in SMN2 transcripts, enhancing SMN2 gene expression, stabilizing the SMN protein or replacing the SMN1 gene. ⋯ Early diagnosis will be crucial for therapeutic success; presumably, the clinical outcome will be much better if treatment already starts presymptomatically. Therefore, presymptomatic diagnosis of SMA via a nationwide genetic newborn screening will be key for an efficient therapy prior to motor neuron death.