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.     

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.     

Neurowissenschaften und Psychotherapie

The rapid development of the cognitive neurosciences is based on interdisciplinary efforts and on a broad repertoire of research methods ranging from molecular biological to functional neuroimaging procedures suitable for the study of complex, ongoing intrapsychic processes. Selected recent results that are relevant for psychotherapy are discussed. They are based on genetics, on animal studies about the impact of early relational experience on brain development, further on memory research, on functional neuroimaging (PET, fMRI), and on first studies about the impact of psychotherapy on the brain. Neuroscience studies confirm some major psychoanalytic hypotheses (crucial role of early experience, unconscious processing) and question others (e. g. structural models). They help to overcome the split between “somatic” and “psychological” theories and treatments and open new, interdisciplinary research perspectives for psychotherapy.     

Das Symptom Schwindel im Fokus der Psychiatrie

Das Symptom Schwindel wird in der klinischen Praxis organisch meist regelrecht durch die zuständige Fachrichtung abgeklärt. Ein möglicher psychiatrischer Impact im Symptom Schwindel wird oft übersehen und somit vernachlässigt. Die Folge ist ein Persistieren und Chronifizieren einer Symptomatik, die unter dem Namen phobischer Schwindel bekannt ist. Neuere Begriffe wie die somatische Symptomstörung des DSM‑5 und der heute stigmatisierende Begriff des somatoformen Schwindels werden in diesem Fallbericht klinisch und theoretisch umrissen. Sofern der phobische Schwindel richtig diagnostiziert wird, kann im Rahmen eines Gesamtbehandlungsplanes unter Einbeziehen von Physiotherapie, dem Erlernen von Angstbewältigungsstrategien und adäquater Aufklärung und Information des Betroffenen konkret an Beschwerden gearbeitet werden. Voraussetzung dafür ist ein interdisziplinäres Denken beim behandelnden Arzt. Im Fallbericht geht es um einen älteren Patienten, der neben schwerwiegenden körperlichen Ursachen für Schwindelsymptome letztlich einen phobischen Schwindel bietet, der nach der richtigen Diagnosestellung umfassend behandelt werden kann.     

Sprache, Neurowissenschaften und Psychoanalyse

In this article some general thoughts on the application of language in psychoanalysis and psychotherapy will be expressed against the background of the most recent findings in linguistics, neurolinguistics and neuroscience. The conclusion is that consideration of the subsymbolic/symbolic linguistic development of a child and the affective coordination between child and environment is of fundamental importance in the psychotherapeutic relationship.     

Zum Stand der forensischen und forensisch-psychiatrischen Nachsorge in der Bundesrepublik Deutschland (Daten aus der sog. Pfingstabfrage 2013)

In 2007 forensic aftercare was integrated into the German Penal Code as part of legal supervision. Since then a large and growing number of patients have been supervised by forensic psychiatric aftercare units throughout Germany. Due to the federal system in Germany the system of forensic aftercare has developed differently in the 16 federal states. The number of patients looked after varies widely and the implementation of several legal norms also differs from state to state. This article gives an overview of the situation of forensic aftercare in the different German federal states and presents some specific characteristics of the development.     

Ein experimenteller Beitrag zum Problem der psychologischen Grundlagen der Namengebung

Ohne Zusammenfassung