Der Nervenarzt
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The availability of mental health resources in most developing countries is poor due to scarcity of resources, competing health problems, and the low priority given to mental health issues. In Nigeria, modern psychiatric care is developing, but as yet most people have no access to it because they cannot afford the treatment. ⋯ The cooperation between the authors of this article is aimed at improving the provision of psychiatric care for people living in Ibadan, Nigeria and rural areas close to the city. We report about the foundation of an association to provide help for mentally ill patients in Africa.
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Based on patient reports, animal data, and in vitro experiments, evidence has emerged indicating a positive effect of cannabinoids as symptomatic treatment of spasticity and pain in multiple sclerosis. The recently published CAMS study was the first multicenter, randomized, placebo-controlled phase III trial to examine the efficacy of cannabinoids on symptoms related to MS. ⋯ A major problem of the study was a high degree of patient unmasking in the active treatment group. In this review, the results of the CAMS study are discussed in the context of previous trials, the putative mechanism of action of cannabinoids and their adverse event profile.
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Comparative Study
[Costs of stroke unit care in Germany. Resource use and reimbursements by German diagnosis related groups].
Stroke care has a high impact on health costs. Therefore, the costs and reimbursements of integrated stroke care were calculated in a German neurological university hospital. ⋯ The development of reimbursements by the G-DRGs shows a clear downward trend and shows that the high resource use in stroke unit care is inadequately reflected by the G-DRGs.
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Brain imaging studies with PET, SPECT, functional magnetic resonance imaging, and spectroscopy provide evidence of prefrontal dysfunction in schizophrenia. Dysfunction of the prefrontal cortex is associated with cognitive impairment and negative symptoms. Combined multimodal imaging shows that a developmentally early disturbance of frontotemporal-limbic neuronal networks is associated with a disinhibition of subcortical dopaminergic neurotransmission. ⋯ Some studies also indicate that atypical neuroleptics may at least partially improve frontal cortex function. We review the literature and discuss genotype and medication effects on frontal dysfunction in schizophrenia. Molecular brain imaging combines imaging techniques with the assessment of genotype effects and represents a powerful tool for the understanding of neuropsychiatric disorders.
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The diagnostic criteria of restless legs syndrome were defined in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). In light of the latest scientific evidence and increasing clinical experience, the diagnostic criteria were revised in a consensus workshop. Participants of the workshop considered the development of new diagnostic criteria especially important for the following subgroups: (1) for children and (2) for the cognitively impaired elderly. ⋯ The proposal was partially incorporated into the diagnostic criteria for restless legs syndrome in childhood suggested by the IRLSSG. The current criteria are recommendations to enhance further research and must be validated by clinical studies. The following article gives an overview of published studies on restless legs syndrome in childhood, reviews the proposals for diagnostic criteria, and summarizes the peculiarities to be considered in diagnosing restless legs syndrome in children.