Benzodiazepine im Fokus

Benzodiazepines (BZDs) are widely disseminated because of their good compatibility and safety profile. But the long-term use appears problematic and is likely to be associated with sleep disorders, increased anxiety, concentration problems, cognitive losses and physical discomfort. A BZD long-term intake syndrome can be hypothesized, with a risk of dementia development.     

Das DGPPN-Zertifikat Forensische Psychiatrie

The introduction of the German Society for Psychiatry Psychotherapy and Mental Health (DGPPN) certificate for forensic psychiatry significantly contributed to improving the quality of forensic psychiatric expertises. The corresponding designations of state medical boards were created in 2004 and have now become established. Currently two methods of certification of forensic psychiatric training are possible which opens up the opportunity to further develop the certificate and to set standards for quality assurance. This article discusses in particular quality control measures, ways to respond to serious quality issues and the development process in terms of a continuing medical education. By establishing and enforcing such standards the DGPPN will achieve a key position.     

Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

Fortschritte der Psychiatrie

Die Psychiatrie hat sich in den letzten 100 Jahren zu einer faszinierenden Wissenschaft entwickelt: Es ist ihr gelungen, Forschungsergebnisse aus allen benachbarten Disziplinen einzubinden, aus den Neurowissenschaften, der Soziologie, den Kulturwissenschaften und der Psychologie. Dies erkl?rt auch den gewaltigen Erkenntnisfortschritt und die – in der Tat sensationellen – Therapieerfolge unseres Faches.     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.     

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.     

Das Cliffsche Gesetz im Deutschen

Zusammenfassung Werden Adverb-Adjektiv-Kombinationen als ethische Urteile über Menschen gebraucht, so ist der Skalenwert der Kombination auf einer Verhältnisskala als Produkt des Werts des unmodifizierten Adjektivs auf dieser Skala und eines skalenunabhängigen Multiplikators, der Stärke des Adverbs, auffaßbar. Dieses von Cliff für das Amerikanische, Englische, Australische und Französische aufgestellte Gesetz wird auch im Deutschen nachgewiesen. Deutsche Adverbien und ihre amerikanischen Wörterbuchübersetzungen werden hinsichtlich ihrer Stärken verglichen. Übereinstimmung ergibt sich keineswegs in allen Fällen. Es wurde eine Analysetechnik entwickelt, die nur eine gewöhnliche Tischrechenmaschine voraussetzt.     

Diagnostischer Prozess und Voreingenommenheit in der forensischen Psychiatrie

This article analyses the problem of bias and confirmatory bias in the diagnostic process. The analysis is situated mainly within the context of the legal system in the United States but also with consideration of the situation in Germany. Special attention is given to the conceptual history and the development of modern operational classifications, particularly the Diagnostic and Statistical Manual of Mental Disorders (DSM) system.     

Das Unheimliche der Ambivalenz

This essay??s main concern consists of a critical survey of the coherences, alliances and associative entanglement between psychic ambivalences, encounters of the uncanny and the connections to the issues of death. References for the considerations presented here are Freuds??s seminal papers ??The antithetical meanings of primal words?? (1910), ??The uncanny?? (1919) and ??Beyond the pleasure principle?? (1920). The axis formed by these essays is being crisscrossed by the phenomen of the uncanny valley, an issue widely discussed within the cyber scene which may introduce a new perspective in order to extend the analysis of the concept and structure of ambivalences with new questions. This approach adverts to an inherent paradox which seems to be constitutive for ambivalence itself.     

Das handelnde Subjekt im Historischen Materialismus

Ohne Zusammenfassung     

Das Problem der Chronometerauswahl

On Choice of Time Metric. What criteria ought to be satisfied by those observable processes which, accompanied by a function assigning values to intervals of that processes, serve as the standard for measurement of time? In how far do the criteria which can reasonably be established admit of an unambigous definition of time metric? That are the questions to which I have addressed myself in the paper. Peter Janich has aimed at solving the problem with careful avoidance of any reference to physical theory. Although this paper owes a great deal to his ‘Protophysik der Zeit’, reasons will be ad-vanced that it is in principle impossible to give a foundation of time metric without any reference to physical theory. It follows that taking results of physical theory into account is unavoidable as far as a definite decision concerning the choice of time metric is aspired. At first sight reference to law-like assertions on the duration of temporal intervals appears to be paradoxical for it means to take something which originally ought to be submitted to experimental test as the standard for measurement. Poincaré is fairly conscious of this problem, yet explicitly acknowledges that there is a mutual relationship between definition of time metric and physical theory. It will be shown that this kind of mutual relationship which even might be termed as circular does not void physical theory of empirical content. Thus in the final part I am concerned to free the position which recommends reference to physical theory from its paradoxical image in order to advance a conventionalist account as a sceptical, but nevertheless fully satisfying solution.