Psychiatry In Germany Research Articles

Characteristics of clinical-pharmacological recommendations in psychiatry in Germany.

Psychiatric patients in general, and elderly psychiatric patients in particular, are at risk of adverse drug reactions due to comorbidities and inappropriate polypharmacy. Interdisciplinary and clinical-pharmacologist-led medication reviews may contribute to medication safety in the field of psychiatry. In this study, we reported the frequency and characteristics of clinical-pharmacological recommendations in psychiatry, with a particular focus on geriatric psychiatry. A clinical pharmacologist, in collaboration with the attending psychiatrists and a consulting neurologist, conducted interdisciplinary medication reviews in a general psychiatric ward with a geropsychiatric focus at a university hospital over a 25-week period. All clinical and pharmacological recommendations were recorded and evaluated. A total of 316 recommendations were made during 374 medication reviews. Indications/contraindications of drugs were the most frequently discussed topics (59/316; 18.7 %), followed by dose reductions (37/316; 11.7 %), and temporary or permanent discontinuation of medications (36/316; 11.4 %). The most frequent recommendations for dose reduction involvedbenzodiazepines (9/37; 24.3 %). An unclear or absent indication was the most common reason for recommending temporary or permanent discontinuation of the medication (6/36; 16.7 %). Interdisciplinary clinical pharmacologist-led medication reviews represented a valuable contribution to medication management in psychiatric patients, particularly the elderly ones.

Perceptions of interprofessional collaboration at the intersection of child welfare and child and adolescent psychiatry in Germany

In Germany (and other countries) a significant proportion of children and young people in contact with the child welfare system do not receive adequate mental health care. Fragmented service delivery has been partially attributed to a lack of interprofessional collaboration between the child welfare system and providers of child mental health services. Child and adolescent psychiatric (CAP) clinics provide the majority of child mental health care for the child welfare population in Germany. In this paper, we present the first wave of data collected in a nonrandomized pretest–posttest intervention study, in which we examined the collaboration between child welfare services and CAP clinics in Northern Germany with a sample of N = 204 professionals in total, from both organizations. We used two standardized measurements. The general quality of collaboration was measured using an established tool, the “Perceptions of Interprofessional Collaboration Model – Questionnaire” (PINCOM-Q). Perceptions of collaboration around children with complex care needs were measured with a newly developed scale, the “Perceptions of Interprofessional Collaboration Scale for Children with Multiple and Complex Needs” (PICOCC). The results show that perceptions of interprofessional collaboration differed based on organizational and professional affiliation. Frontline workers employed in the child welfare system compared to those working in CAP clinics had a more negative perception of collaboration in general, and felt their organization provided less support for collaboration. Social workers in both CAP and child welfare services perceived less organizational support for collaboration compared to mental health professionals. In the overall group of social workers, those working in the child welfare system felt their organization supported collaboration the least. Mental health professionals working in CAP clinics, however, had a more negative perception of collaboration around children with complex needs. This suggests that attention should be paid to perceptions of interprofessional collaboration as an important process variable, which may impact on frontline workers’ responsiveness to organizational change.

Adverse incidents and therapy options for opioid use disorders in forensic psychiatry

IntroductionPatients admitted into Forensic Clinics for Dependency Diseases (FCDD) in Germany are diagnosed with at least one substance use disorder. Opioid use disorders is common in this clinical population. Surprisingly, data on the availability and practice of opioid substitution treatment (OST) options in German FCDD according to Sect. 64 of the German Criminal Code (StGB) is scarce. Additionally, important data on the prevalence of adverse incidents such as violent behavior, relapse or escape from the clinic are missing for this highly specific treatment setting.ObjectivesOur aim ewas to describe the clinical practice regarding opioid substitution therapy in forensic psychiatry in Germany and to identify the prevalence of relevant adverse incidents during the therapy process.MethodsWe conducted a observational study including all FCDD units in Germany via a questionnaire. We assessed the clinical practice and total number of patients that received an OST, clinical reasons for beginning and ending the OST, number of treatments terminated without success, number of successful treatments and relevant adverse incidents such as violent behavior, relapse, escape and reoffending. The data was analyzed descriptively.Results15 of the existing 46 FCDD participated in our study (33%). In total, 2483 patients were treated in the participating FCDD, 18% of the patients were relocated into prison due to treatment termination and 15% were discharged successfully. 275 adverse incidents were reported: violence against a patient (4%), violence against staff (1,6%), escape (4,7%) and reoffending (0,5%). Merely in seven FCDD treating 1153 patients, an OST was availabe. Available options included buprenorphine/naloxone, buprenorphine, methadone and levomethadone. Regarding adverse incidents and successful discharge, no differences were detected in the clinics with or without an OST. In the clinics that offered an OST, we found a significantly higher rate for treatment termination without success (p<0.007) in comparison to clinics without this program. 99 patients received an OAT and this treatment was ended due to illegal drug abuse (57%), refusal to give an urine drug sample (71%) and in cases were the OAT was given away to other patients (85%).ConclusionsSurprisingly, opioid substitution therapy is only accessible in a part of the FCDD in Germany. Reasons for this are unclear. Critical incidents such as violent behavior against staff/patients and escape are not uncommon in this forensic psychiatric treatment setting. Further studies are needed to enhance the understanding of the limited OST practice and the risks for patients and staff in this specific forensic treatment setting.Disclosure of InterestNone Declared

Medical Students’ Views on Psychiatry in Germany and Italy: Survey

Medical Students’ Views on Psychiatry in Germany and Italy: Survey

Psychoanalysis and Psychodynamic Psychiatry in Germany.

The authors relate the complex and eventful history of psychoanalysis and psychodynamic psychiatry in Germany. After highlighting Wilhelm Griesinger's pioneering efforts, they describe the founding of the first psychoanalytic associations and their evolution under National Socialism and during the post-World War II period. They discuss the contributions of Günter Ammon, the state of psychoanalysis and psychodynamic psychiatry in Germany, current trends, and future directions.

Long Term Evaluation of the Implementation of the Safewards Model - Results of a Follow-Up-Study Among Patients and Staff in Acute Psychiatric Wards

Evaluation of long-term effects of the implementation of the Safewards Model (SM) among staff and patients in acute psychiatry in Germany. Assessment of ward atmosphere, job satisfaction, fidelity, and coercive interventions in 2 locked wards directly before and 15 months after implementation of the SM. Ward atmosphere was assessed significantly better after implementation, job satisfaction was still above-average at both times, coercive interventions declined significantly in one ward, fidelity and degree of implementation were still high. The implementing of the SM in locked wards in acute psychiatry can also have positive effects in long run.

Evaluation of the German Version of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 as a Screening Tool for Adult Attention-Deficit/Hyperactivity Disorder in Primary Care.

Adult attention-deficit/hyperactivity disorder (ADHD) is common, but often undiagnosed. A valid and time-efficient screening tool for primary care is needed. Objective of this study is to evaluate the German version of the Adult ADHD Self-Report Scale for DSM-5 (ASRS-5) and its feasibility, acceptability, and reliability as a screening tool for adult ADHD in primary care. A multi-centered prospective, diagnostic study was performed. We recruited 262 patients in primary care practices and at an ADHD Outpatient Service of a department of psychiatry in Germany. Patients from 18 to 65 years with suspected or diagnosed ADHD were included by medical doctors, as well as non-ADHD patients as “negative controls.” Participants filled in the ASRS-5 and a sociodemographic questionnaire. The Integrated Diagnosis of Adult ADHD, revised version (IDA-R) performed by trained interviewers was used for validation. Feasibility, acceptability, and credibility in primary care practices were examined through a semi-structured interview. The German version of the ASRS-5 showed comparable psychometric properties to the English original version (sensitivity 95.6% and specificity 72.3%). For factor structure, a parallel analysis suggested one latent dimension. Performing confirmatory factor analysis, the best fit was achieved for a general factor with one correlated error. Internal consistency results in Raykovs Omega = 0.86 and Cronbach’s α = 0.88. The ASRS-5 was assessed positively in terms of feasibility, acceptability, and credibility by interviewed general practitioners. Potential problems were raised for “treatment options,” “stigmatization,” and “knowledge gaps.” In conclusion, the German version of the ASRS-5 offers a promising tool to improve adult ADHD patients’ diagnosis and healthcare.

Participatory Research in Clinical Psychology and Psychiatry in Germany - Achievements, Implementation, and a Look to the Future

Participatory Research in Clinical Psychology and Psychiatry in Germany - Achievements, Implementation, and a Look to the Future

Estimation of a preliminary therapeutic reference range for children and adolescents with tic disorders treated with tiapride

PurposeTiapride is commonly used in Europe for the treatment of tics. The aim of this study was to examine the relationship between dose and serum concentrations of tiapride and potential influential pharmacokinetic factors in children and adolescents. In addition, a preliminary therapeutic reference range for children and adolescents with tics treated with tiapride was calculated.MethodsChildren and adolescents treated with tiapride at three university hospitals and two departments of child and adolescents psychiatry in Germany and Austria were included in the study. Patient characteristics, doses, serum concentrations, and therapeutic outcome were assessed during clinical routine care using standardised measures.ResultsIn the 49 paediatric patients (83.7% male, mean age = 12.5 years), a positive correlation was found between tiapride dose (median 6.9 mg/kg, range 0.97–19.35) and serum concentration with marked inter-individual variability. The variation in dose explained 57% of the inter-patient variability in tiapride serum concentrations; age, gender, and concomitant medication did not contribute to the variability. The symptoms improved in 83.3% of the patients. 27.1% of the patients had mild or moderate ADRs. No patient suffered from severe ADRs.ConclusionsThis study shows that tiapride treatment was effective and safe in most patients with tics. Compared with the therapeutic concentration range established for adults with Chorea Huntington, our data hinted at a lower lower limit (560 ng/ml) and similar upper limit (2000 ng/ml).

Importance of electroconvulsive therapy (ECT) in forensic psychiatry

Hintergrund und Ziel der ArbeitFür die Elektrokonvulsionstherapie (EKT) liegen Leitlinienempfehlungen zur Behandlung schwerer affektiver und psychotischer Erkrankungen vor, wie sie auch bei Patienten im Maßregelvollzug (MRV) vorkommen. Über die Anwendung der EKT in der forensischen Psychiatrie existieren jedoch keinerlei systematisch erhobene Daten. Ziel der vorliegenden Arbeit ist eine Erhebung des Ist-Zustands sowie des geschätzten Bedarfs an EKT im MRV.Material und MethodenEs wurde ein Fragebogen zur Erhebung der aktuellen Anwendung sowie der Einschätzung des Bedarfs an EKT in dieser Population entwickelt. Dieser wurde elektronisch und bei Bedarf postalisch an die forensischen Kliniken in Deutschland versendet.ErgebnisseWir erhielten Antwort von 52 Kliniken (66 %). 29 der Kliniken gaben an, Patienten mit EKT behandeln zu können. Eine Behandlungsindikation wurde klinikübergreifend für 3,4 % der untergebrachten Patienten gesehen. In einem Jahr (2018) wurden insgesamt 32 EKT-Behandlungen an 12 Kliniken des Maßregelvollzugs mit durchschnittlich guter Wirksamkeit (Ø CGI‑I 2,32) durchgeführt. Häufigste Begründung für die fehlende Anwendung der EKT waren mangelnde strukturelle Voraussetzungen. Jeweils etwa ein Drittel der Kliniken sehen einen mittleren bzw. hohen Bedarf an EKT im MRV.DiskussionDie EKT kommt im MRV in Deutschland aktuell nur sehr begrenzt zum Einsatz. Auffällig ist, dass die Anzahl der durchgeführten Behandlungen etwa um den Faktor 8 hinter der Indikationshäufigkeit zurücksteht. Ungeachtet dessen sehen zwei Drittel der Kliniken einen mittleren bis hohen Bedarf, womit eine Unterversorgung mit EKT im MRV zu bestehen scheint.

Von der Erfindung einer „Krankheit“: Das „psychopathische“ Kind um 1900

At the turn of the twentieth century, more and more school children were considered mentally “abnormal” by pedagogues and psychiatrists. “Psychopathic inferiorities” (Psychopathische Minderwertigkeiten) quickly turned into a fashionable diagnosis. This article deals with the concept of psychopathy, which developed around 1900 in the context of pedagogy and psychiatry, and reconstructs the psychopathologization of school children by pedagogy and psychiatryin Germany. Based on selected case studies, the paper compares their ideas of the so called psychopathic child. By analysing the functions of the discourse about the “psychopathic” child, the author explains the significant success of the diagnosis “psychopathy”.

Changes on Ward Atmosphere and Job Satisfaction after Implementation of the Safewards Model in Two Locked Acute Psychiatric Wards - A Multi-Perspective Evaluation

Evaluation of the changes of ward atmosphere and job satisfaction after the implementation of the Safewards model in acute psychiatry in Germany. A multi-perspective pre-post study design was conducted in two locked wards among patients (n = 80) and staff (n = 88) before and after the implementation of the Safewards model over a period of 12 months. After the implementation of the Safewards model, ward atmosphere and job satisfaction improved. Both correlated positively amongst staff. Furthermore, job satisfaction correlated positively with a high degree of implementation of two interventions. Fidelity to the Safewards model was high. Implementing the Safewards model in acute psychiatry with high fidelity can have positive effects on positive ward atmosphere and job satisfaction. Thus, patients as well as staff benefit from this model. With regards to high fluctuation in acute psychiatry, the implementation of the Safewards model can additionally facilitate retention management.

The Care of Intellectually Disabled Children and Adolescents with Psychiatric Disorders in Hospitals for Child and Adolescent Psychiatry and Psychotherapy in Germany

This study explores the care situation of children and adolescents with intellectual disabilities (ID) suffering from mental problems in Germany in 2014. It complements the study of Hennicke, which was conducted a decade ago. All clinics and departments of child and adolescent psychiatry in Germany (n=138) were contacted via mail or personally and requested to fill out a questionnaire. We received data from one-third (n=46) of all hospitals contacted. Eight hospitals (17%) offered specialized services for this client base as either inpatient or outpatient treatment. Three hospitals (7%) provided both. Average proportions of children with ID treated were 6.6% for inpatient, 7.9% for day hospital, and 3% for outpatient services. More than half of responding institutions (54%) judged inpatient services as being defective. Slightly less (43%) reported their outpatient services as being defective or inadequate. For the treatment of mental disorders in young patients with ID, different treatments were used, according to the degree of the ID and applying the standard of child and adolescent psychiatry. Some interventions were used independently of the degree of ID, such as practical exercises, interventions in the patient environment (parents, family). Other interventions, such as psychotherapy were used to a lesser degree when the degree of ID increased. Youth with mild ID received twice as much psychotherapeutic interventions compared to children and adolescents with severe ID. The latter received more psychopharmacotherapy instead. Youth with severe ID received twice as much (67%) psychotropic medication compared to children and adolescents with mild ID. The defective care situation of the highly vulnerable children and adolescents with ID did not change much between 2004 and 2014. The amount of specialized care services increased only marginally. Non-pharmacological treatments were used to a larger extent, compared to psychotropic medication, independent of the degree of ID.

Possibilities for Suicide Prevention Through Architecture in Child and Adolescent Psychiatry

Possibilities for Suicide Prevention Through Architecture in Child and Adolescent Psychiatry Abstract. In Germany, departments of Child and Adolescent Psychiatry are responsible for the treatment of young people with acute suicidal tendencies. Therefore, it is important to consider means of preventing suicide already during the construction and business operations of these institutions. Approaches to structural suicide prevention can be divided into restrictive and atmospheric-therapeutic measures. The latter includes ways to create an antisuicidal environment and to establish a setting amenable to close support and care by mental-health professionals. Restrictive measures comprise security measures and means of avoiding potential hazards, for example, through life-threatening jumps (e. g., staircases) or intentional strangulation (e. g., employing materials with predetermined breaking points). In addition to security issues, architectural and creative aspects must be incorporated to enable a suicide-preventive atmosphere, that is, satisfying protective needs, creating positive distractions (panoramic views, activities, occupational therapy opportunities), and using positive physiological and natural influences (such as colors and light). Secure access to a pleasant and protected external area as well as exercise spaces is also essential. Architects and construction managers should work closely with the institution's health personnel (e. g., doctors, therapists, and psychiatric nursing staff) during the planning stages for Departments of Child and Adolescent Psychiatry in order to come up with solutions that comprise appropriate, practical, and functional requirements and safety-restrictive measures. Thus, an inviting and atmospherically pleasant space can be created that simultaneously provides suicide prevention and protection, where adolescents with psychiatric disorders can be treated by mental-health professionals.

Polypharmazie in der Anwendung von Psychopharmaka in der deutschen Kinder- und Jugendpsychiatrie – häufiger Regel als Ausnahme

Polypharmacy of psychotropic drugs in child and adolescent psychiatry in Germany - rather the rule than the exception Abstract. Background: Polypharmacy increases the risk of interactions and enhances the chance of adverse drug reactions (ADRs). Hence, child and adolescent psychiatrists generally try to avoid polypharmacy with psychotropic drugs. However, only little data regarding the frequency of polypharmacy in child and adolescent psychiatry are available. This study analyzes clinical data on polypharmacy and the possible association with a higher risk of ADRs in Germany, with a focus on antidepressants and antipsychotics. Methods: We investigated a total of 940 datasets from descriptive studies on therapeutic drug monitoring (TDM) of pediatric patients treated with different psychotropic drugs. Results: The frequency of polypharmacy ranged up to 45.6 % (escitalopram) and 72.1 % (olanzapine). In 17.4 % of the cases, polypharmacy consisted of four or more psycho-/neuropharmacological substances. No increased incidence of ADRs was reported with polypharmacy of antipsychotics compared to monotherapy. Polypharmacy with sertraline was associated with a higher number of ADRs. Discussion and Conclusion: There is a high prevalence of polypharmacy with psychotropic drugs in child and adolescent psychiatry in Germany. Conclusions concerning individual drugs should be drawn with care since the subsample sizes were relatively small. However, our results do provide an indication of the prevalence of polypharmacy, although the validity of the data is limited. There is an urgent need to analyze data from larger and more homogeneous groups under more controlled conditions.

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives Abstract. Abstracts: Method: Review of the historical background and implementation of an independent medical specialty "child and adolescent psychiatry" (CAP) in Germany. Results: The implementation of an independent specialty for CAP in 1968 was crucial for the progressive further development of the discipline. The Enquête Commission "Psychiatry" of the Federal Government, followed by the Model Program "Psychiatry", the Staff Regulations for Psychiatry, the Agreement on the Social Psychiatry and the Psychotherapy Act have had significant impact on the care for psychiatrically ill children and adolescents and their families. This led to an institutional anchoring of new structures, covering three of the four leading principles of the Model Program, namely integration into medicine, community-based and appropriate care. Equality of psychiatric patients with other patient groups has, nevertheless, not yet been achieved and is still to be claimed. Current and future challenges are: (1) The realistic evaluation of new research methods and epochal trends and elimination of opposites, (2) the establishment of future-oriented research initiatives, (3) the intensive promotion of clinical and scientific staff members, and (4) a renewed attention for the subjective perspective of the illness. Conclusions: The implementation of an independent specialty "child and adolescent psychiatry" was an important stimulus for the further development of the discipline. Essential demands for the future will be: the integration of CAP into the curriculum for medical students and the promotion of young researchers within the scope of regional and supra-regional projects.

The influence of the UN Convention on the Rights of Persons with Disabilities on the German jurisdiction and legalisation regarding compulsory measures

The UN Convention for the Rights of People with Disabilities (CRPD) has influenced the jurisdiction and legislation on psychiatry in Germany. It played a role in several landmark decisions of the Federal Constitutional Court and of the Federal Supreme Court, which again initiated changes of the guardianship law and of different federal mental health laws. Furthermore, the CRPD has triggered an intensive discussion within psychiatry, which has led to a more critical and cautious use of coercive measures.However, the interpretation of the CRPD is controversial. The UN Committee on the Rights of Persons with Disabilities has published in 2014 a "General Comment on Article 12 of the UN Convention". Therein, the Committee interprets the CRPD in a way that differs questionably from former international statements about human rights and from former WHO recommendations. Particularly, the Committee demands the complete abolition of substitute decisions by legal guardians and the complete elimination of confinement and of coercive measures.The German government does not accept the Committee's interpretation of the CRPD. The Federal Constitutional Court has declared that the Committee's statements are not legally binding under public international law, neither for national nor for international courts. Furthermore, the Federal Constitutional Court has criticized the Committee's position. Particularly, it has declared that the CRPD does not imply a total ban of substitute decisions and coercive measures. The Federal Constitutional Court rather acknowledges the state's duty to protect especially those people who cannot decide freely and who are in a helpless situation because of illness or disability. The Court has declared that the state must not abandon these people to their fate.The Federal Constitutional Court has interpreted the CRPD by balancing different fundamental rights and by differentiating between the free and the natural will. In contrast, the Committee has absolutized a naïvely understood right for self-determination.

Einhaltung der Menschenrechte in der Psychiatrie

The article provides an overview of the origins and practical work on national and international control mechanisms, initiated by the United Nations, for the observance of human rights in psychiatry in Germany and worldwide. Historical, legal and psychiatric developments will be presented ranging from Pinel 200 years ago to the Universal Declaration of Human Rights in 1948 and the United Nations Convention against Torture (CAT). The National Agency for the Prevention of Torture and Ill-treatment in Germany will be presented, which has visited about forty psychiatric institutions since its establishment and has reported its observations to the public. This is followed by impressions of visits by the Subcommittee on the Convention against Torture, the SPT, in different states in which the first author participated. As the diction of national and international reports may be tacitly influenced by western ideas, a discourse about dementia in the Islamic cultural area follows. The aim of the article is to provide an incentive to discuss bioethical issues taking into account multiple perspectives. The importance of civil society organizations for the future development of an interdisciplinary and intercultural exchange will be elaborated.

Smoke-free psychiatry in Germany: A closer look

In order to protect non-smokers, the federal states of Germany have adopted a law that provides for extensive smoking bans. In many of these federal laws, acute psychiatric facilities are treated as an exception. Therefore, it is often up to the institutions themselves to develop and enforce regulations. The aim of this study was to evaluate the situation in acute psychiatric facilities. The survey was created on the basis of previously evaluated questionnaires and consisted of 53 questions. A total of 289 hospitals were contacted. Participants were invited to take part in the survey via e-mail. 59 hospitals (20.4 %) participated in the survey. Binding regulations were in place in 48 (81.4 %) hospitals, in 26 (44.1 %), smoking was prohibited on open wards. Three hospitals (5.1 %) strictly prohibited smoking on locked wards. Stop-smoking medication was available in 31 (55.3 %) hospitals. 19 (32.2 %) offered smoking cessation interventions. 22 (37.3 %) hospitals have set up a working group on the subject. Currently, the issue of smoking in psychiatric facilities does not receive enough attention. The physical and mental health of psychiatric patients would benefit from a smoke-free policy. In order to achieve this, psychiatric staff and patients need appropriate support.

Arterial Hyper- and Hypotension associated with psychiatric medications: a risk assessment based on the summaries of product characteristics (SmPCs)

Introduction Psychiatric medications are well-known triggers of clinically relevant blood pressure changes. Therefore, we aimed at creating ranking lists for their risk of causing arterial hyper- or hypotension. Methods We analyzed 784 Summaries of Product characteristics (SmPCs, available online from "Rote Liste" or "Gelbe Liste" websites) from 105 psychiatric medications registered in adult psychiatry in Germany and extracted the standardized reported risks of increasing or decreasing arterial blood pressure. Results According to the SmPCs, atomoxetine had the highest risk of arterial hypertension ("very frequent", > 10 %), and another 15 substances followed in the category "frequent" (> 1 %): duloxetine, milnacipran, venlafaxine, bupropion, citalopram, tranylcypromine (particularly with certain diets), reboxetine, methylphenidate, clozapine, paliperidone, risperidone, buprenorphine+naloxone, memantine, galantamine, and rivastigmine. Conversely, 7 substances, namely amitriptyline, tranylcypromine, chlorprothixen, flupentixol, levomepromazine, olanzapine and trimipramine had the highest reported risk of low blood pressure ("very frequent"), and another 25 substances had the risk "frequent". No risk of hypertension or hypotension was documented for many other substances. Incidentally, we observed that the reported effects on blood pressure for single substances (e. g. citalopram) markedly differed between the SmPCs from different manufacturers, rendering a clear risk assessment impossible for many medications. Discussion According to the German SmPc, many psychiatric medications are associated with the risk of arterial hypertension and, even more so, hypotension. We hardly observed substance group effects, such as high blood pressure with noradrenergic antidepressants. Commonly used tables summarising secondary causes of arterial hypertension should be revised in terms of psychiatric medications. Our rank orders ofrisk may aid choosing the best psychiatric medications in patients with known hypertension or at risk for syncope, as well as when blood pressure changes occur under psychiatric pharmacotherapy. A definitive risk assessment however requires controlled studies.