The psychiatrist Heinroth--a critical reflection

Heinroth (1773-1848) belongs to the founders of psychiatry in Germany. He represented an idealistic, spiritualistic psychiatric school that had a strong leaning towards materialist ideas. He believed that mental disturbances were caused by guilt and sin. But, besides these speculations, he also expressed views that led to view psychiatric and psychotherapeutic insights. One of these was his postulated psychogenesis of mental disturbances. His thoughts on the importance of social, biographical and psychosomatic factors also contributed to the development of psychiatry.     

Gewalttaten psychisch Kranker

Only a minority of mentally ill persons become conspicuous due to acts of violence. Nevertheless, from time immemorial there has been a certain fear of the alleged unpredictability of the mentally ill, particularly of people who suffer from a psychosis. The creation of psychiatry as an independent medical discipline was designed from the very beginning to separate people deemed to be dangerous from society and to detain them in institutions in order to heal them, to make relevant improvements or to keep them indefinitely. The movement of dehospitalization since the 1970s, which in turn was a consequence of revolutionization of treatment options through modern neuroleptic and antidepressive drugs, led to a distinctive separation between general psychiatry and forensic psychiatry, institutionally (general psychiatric institutions with periods of hospitalization of a few weeks and psychiatric forensic committment lasting many years) as well as increasingly more in scientific discourses; however, a close cooperation is necessary for healthcare treatment, which meets the requirements of patients and also public security. In this respect general psychiatry must still undertake substantial safety reponsibilities, which it can learn from forensic psychiatry, whereas forensic committment must rapidly acquire the therapy experience of general psychiatry.     

The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.     

Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

Psychiatry of the physician J.C. Reil--a critical view

Reil (1759-1813) was one of the doctors who developed psychiatry in Germany. He represented a materialist psychiatry with dialectical aspects. His concept, which was orientated mainly on therapy, is based on the assumption that mental disturbances can be healed. He proposed the establishment of psychiatric hospitals in order to eliminate the hospitalization of the sick in the same building as healthy and to permit the application of specific forms of treatment. The methods he used to heal mental disorders were partly repressive, but they also contained elements of psychotherapeutic treatment.     

Senior citizens group: The supervisory process (A case of parallel processes in multiple systems)

As cost-effective treatment becomes mandatory, preventive psychiatry support groups in community settings offer one solution. The authors describe their experience establishing a group at a Senior Citizens Center. They focus on the supervision of the PGY III psychiatry resident who led the group and how the supervisory process reflected the conflicts in multiple systems: the group, the Senior Citizens Center, the hospital, and supervision. Guidelines are offered for establishing such groups.     

Zertifizierung, Rezertifizierung und Aufrechterhaltung der Zertifizierung in forensischer Psychiatrie in den USA

Certification in forensic psychiatry in the United States has previously included testing for the appropriate fund of knowledge and in various ways and degrees the skills needed to practice this subspecialty competently. Today explicit attention is increasingly being given to supporting methods for forensic psychiatrists to systematically identify and then fortify areas of weakness in forensic knowledge and skill sets. The development of certification in forensic psychiatry can be traced through four phases: (1) certification in general psychiatry by the American Board of Psychiatry and Neurology (ABPN) a prerequisite for certification in forensic psychiatry in each of the three certification phases to follow, (2) certification in forensic psychiatry by the American Board of Forensic Psychiatry (ABFP), (3) certification and recertification in forensic psychiatry by the ABPN and (4) certification, recertification and maintenance of certification by the ABPN. The level of actual competence has always been a challenge to assess adequately and today is both supported and further challenged by measures designed to encourage a lifetime of learning and focused self-improvement required through the ABPN??s maintenance of certification program.     

Sense and nonsense in the social psychiatry concept

The term social psychiatry was justified when coined as a name denoting a psychiatric sub-discipline in order to promote the development of this specific aspect of psychiatric research and practice which, at the time, ran counter to established theory. At present, however, social psychiatry is in danger of becoming isolated, of developing in the boundary regions of psychiatric practice, and thus failing to fulfil its actual role of permeating psychiatry as a whole. The term social psychiatry is regarded as an expression of this isolation and should be avoided.     

Standardisierte Dokumentation als Methode der Qualit?tssicherung

Quality assurance is one of the recurrent topics in forensic psychiatry and the first methods used were systematic documentation and the development of structured assessment and documentation instruments. In German speaking countries the forensic psychiatric documentation system (FPDS) was derived essentially from the AMDP (working group for methods and documentation in psychiatry) system used in clinical psychiatry and consisted of a modular instrument with a basic module and additional ones for the assessment of violent offenders or of sex offenders for risk assessment etc. The development of comparable instruments became especially popular for risk assessment in different settings and for different offender populations. Even more important was that it initiated a platform for scientific exchange, producing a reliable data base, structured training in forensic psychiatry and evaluation of expert reports. Systematic documentation using instruments was often criticized for reducing information and overlooking the complexity of the problems encountered in forensic psychiatry. The critics, however, often do not seem to be aware of the real quality of forensic assessments and reports, of the variety or of the minimal information they often contain. Systematic documentation serves to find a common language among the experts and the courts to improve the assessment of reliability and validity of the information provided, to establish minimal requirements for the formulation of reports and to prove professionally correct handling of cases in litigation against an expert.     

Beitrag der Neurowissenschaften zur forensischen Psychiatrie

Forensic psychiatry is a subspecialty dedicated to the interface between psychiatry and law. It uses paradigms and knowledge from general psychiatry for diagnostics, assessment, therapy and research under consideration of the special requirements of legal aspects and framework conditions; therefore, scientific development in forensic psychiatry is substantially dependent on scientific progress in psychiatry and thus nowadays also in neurosciences. Neurobiological hypotheses on the neuronal foundations of psychiatric diseases have been established, for example the dopamine hypothesis for schizophrenia, in a manner that led to important therapeutic advances in the treatment and long-term quality of life for affected persons. Analogous advances should not be withheld from forensic psychiatric patients, who are doubly affected by the disease and the accompanying limitations in their rights to freedom, which is why research in this field must be driven forwards. Clear advances in knowledge of the neurobiological foundations of forensic psychiatric illnesses have, for example, already been made in the field of pedophilia and psychopathy. Based on studies of investigation populations, such neuroscientific knowledge on the neurobiological principles of forensic psychiatric diseases, however, requires a carefully concerted communication with respect to dissemination in the media as well as in the interpretation of individual cases, for example in court. This is of great importance in order to prevent simplifying misconceptions and to avoid a subsequent loss of trust in the scientific process. Therefore, training of the new generation of forensic psychiatrists in the understanding and communication of scientific methods of modern forensic psychiatric neuroscience is of great importance for the societal impact and further advancement of the discipline.     

Frequently cited journals in forensic psychology

Works cited in six forensic psychology journals published 2008-2010 were counted to identify the most frequently cited journals. The sample of works cited (N = 21,776) was not a definitive ranked list of important journals in forensic psychology, but was large enough to indicate high-impact journals. The list of frequently cited publications included more general psychiatry and psychology journals than titles specific to forensic psychology. The implications of the proportion of general versus specific titles for collections supporting research in forensic psychology were discussed.     

NS-Euthanasie in Österreich von 1939–1945 (Teil 2)

The end of the Third Reich in the spring of 1945 led to discontinuation of the careers of directors (some of whom were indeed able to continue their careers after 1950 at another location) of psychiatric institutions at both university hospitals and institutions (with one exception). Their successors were partly those removed as office directors in 1938–1939 or replacements from the secondary hierarchical level that had not been corrupted by Nazi party membership and were mainly long-term employees of the institutions (all of which continued to fulfill their functions), i.e., reestablishment or continuity of the time before 1938. Despite the at least temporary elimination of staff who were NSDAP members, other employees continued to work—to what extent, remains largely unexplored. Direct offenders were prosecuted, but there was no broader discussion in society or in psychiatry regarding the events that took place. As in society in general, it was about rebuilding and not about reappraisal of the events of the past.     

Standards nichtstrafrechtlicher psychiatrischer Begutachtung

The introduction of the certificate for forensic psychiatry of the German Association of Psychiatry, Psychotherapy, Psychosomatics (DGPPN) in 2000 was a significant contribution to raising awareness of the formal and substantive requirements for forensic psychiatric evaluations and to develop a systematic quality improvement in forensic psychiatric expert services. By the special dominance of the certification in the field of penal law assessment, this proved to be problematic for many predominantly non-penal experts. This led to a requirement to develop a qualification for the non-penal expert opinions. In particular the increasing specialization of the psychiatric disciplines and the diversity of the legal issues and framework require a continuing education in the field of non-penal psychiatric assessments. Substantive and formal requirements are discussed and a continuous process of quality improvement and assurance is outlined. Last but not least a plea is made for close interdisciplinary exchange with the jurisprudence and the courts in the context of quality circles.     

The effects of behavioral activation therapy with inpatient geriatric psychiatry patients

This study examined the effects of Behavioral Activation (BA) treatment on depressive symptoms and quality of life among older adult patients in a geriatric psychiatry facility. There were 50 participants with mild to moderate cognitive impairment, each being 65 years of age or older. A 2 (between) × 3 (time of measurement) design was used in this study comparing control (treatment-as-usual) and experimental (BA) conditions at pre-, mid-, and posttreatment. BA consisted of eight 30- to 60-minute sessions across 4 weeks. Intent-to-treat analyses indicated a significant Group × Time interaction on depressive symptoms, with this effect remaining when only completer data were included. Further analyses indicated that this effect was due to significant change early in treatment in both the full and completer samples. There was no evidence of a significant effect on the quality-of-life measure. Cognitive status was not related to change in depressive symptoms, suggesting that BA may be useful across a range of older adults.     

Der Weg der Psychoanalyse nach Japan

The establishment of psychoanalysis in Japan was a consequence of opening the country to the influence of the western world by the Meiji restitution of 1868. Thus western psychological thought was also spread to Japan. On this basis, psychoanalysis developed through personal contacts and experiences of individuals and infiltrated into intellectual circles and finally into psychiatry. The establishment of two psychoanalytical societies, one for analysts and one where also lay people had access led to a specific and unique organizational structure. The ??Japanese way?? of psychoanalysis is on the one hand characterized by the confrontation with Buddhism and on the other by specific applications which reflect a certain reserve in the Japanese society to the ??standard procedure?? of psychoanalytic therapy. In this way psychoanalysis in Japan implants a diversity into the international discourse which opposes the current trend towards general homogenization.     

Informed consent in psychiatric practice: The primacy of ethics over law

In recent years, concern with informed consent in psychiatry has led to an overemphasis on legal formulations of the problem and a heated debate about when physician paternalism can be justified. This paper proposes that the principle of respect for persons provides better guidance for treatment decisions than do legal guidelines based on a questionable standard of competency.     

Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.     

Relation of Psychiatric Symptoms with Epilepsy,Asthma, and Allergy in Youth with ASD vs. Psychiatry Referrals

The present study aimed to characterize the association of psychopathology with the clinical correlates of epilepsy, asthma, and allergy within and between neurobehavioral syndromes. Participants were consecutively evaluated youth (6–18 years, 75 % male) with autism spectrum disorder (ASD; n = 589) and non-ASD outpatient psychiatry referrals (n = 653). Informants completed a background questionnaire (parents) and a psychiatric symptom severity rating scale (parents, teachers). Youth with ASD had higher rates of epilepsy and allergy but not asthma than psychiatry referrals, even when analyses were limited to youth with IQ ≥ 70. Somatic conditions evidenced variable associations with medical services utilization, educational interventions, family income, and maternal education. Youth with ASD with versus without epilepsy had more severe ASD social deficits (parents’ ratings) and less severe ASD repetitive behaviors (teachers’ ratings). Epilepsy was associated with more severe depression, mania, and schizophrenia symptoms in youth with ASD. Youth with allergy (psychiatry referrals only) had more severe anxiety and depression symptoms (parents’ ratings) but less severe aggression (teachers’ ratings) thus providing evidence of both context- and diagnostic-specificity. Youth with ASD versus non-ASD psychiatry referrals evidence a variable pattern of relations between somatic conditions and a range of clinical correlates, which suggests that the biologic substrates and psychosocial concomitants of neurodevelopmental disorders and their co-occurring somatic conditions may interact to produce unique clinical phenotypes.     

Telepsychiatry services at a tribally run behavioral health clinic

Telepsychiatry provides a helpful resource to rural, poor, and isolated communities for whom traditional psychiatry may not be an option. Focusing on a tribally run behavioral health clinic, this article describes the clinic's transition from traditional psychiatry to telepsychiatry and then delineates benefits and challenges of telepsychiatry in this setting. Telepsychiatry is recommended based on the experiences of this clinic serving a large southwestern Native American community. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Event-related potentials in psychiatry--methodologic principles

The methodological requirements for the use of event-related brain potentials (ERPs) in psychiatry are critically reviewed. In particular the development of psychophysiological models is considered as essential for a functional interpretation of ERP-experiments. In addition problems of signal-analysis and clinical diagnosis relevant to ERP-research in psychiatry are briefly discussed. The logic of ERP-research in psychiatry is illustrated by a series of dichotic listening experiments.