Alkoholabhängigkeit in der psychiatrischen Klinik

In Germany 2.4?% of the population suffer from alcohol dependency and 3.8?% of adults from alcohol abuse. Despite an extensive number of options available for addiction therapy only a minority of affected persons receive addiction-specific therapy. This results in a chronification of the disease and a reduction of approximately 15 years in life expectancy. Background knowledge of the foundations of alcohol addiction leads to a new understanding of the processual course of the disease as well as to new therapy interventions. Individualized treatment includes a combination of outpatient, partial inpatient or inpatient therapeutic measures and range from medical advice for reduction of alcohol consumption, to qualified withdrawal treatment up to pharmacological relapse prophylaxis and long-term weaning treatment. Under current therapeutic conditions abstinence quotas of 50-70?% over 1 year can be achieved. Treating physicians must have sufficient diagnostic certainty and furthermore must be in command of motivating discourse techniques, knowledge on the therapeutic options of outpatient and inpatient withdrawal treatment, pharmaceutical relapse prophylaxis and mediation in rehabilitation measures.     

Therapie und Therapiebeurteilung als Grundlage juristischer Entscheidungen

The idiosyncratic focus of German legal politics on sexual crimes and the extension of preventive detention has led to an unhoped-for career of the juridical therapy expections of the penal system. The basic justification and necessity of an expansion of “treatment detention” particularly in the therapeutic form will be clarified. People detained under preventive detention are not sick but their disposition to undertake serious crimes can be considered as a condition in need of therapy and nursing. Even the “mental disorder” of the Therapy Detention Act (ThUG) is, according to the author, nothing more than this “disposition” to § 66 of the Penal Code. Of course therapy leads to obviously positive results in only some of the convicted felons but nevertheless it is worth it. The newer form of preventive detention takes over considerable tasks and responsibilies from the never realized social therapeutic mental institution (in the sense of a “reprimand solution”).     

Metaphysik des Mechanismus im teleologischen Idealismus

In this study the notion of mechanistic entities is analyzed as it has been conceptualized by Hermann Lotze in his article Life. Vital Force (1842), the metaphysical foundation of which has recourse to his Metaphysik (1841) and Logik (1843). According to Lotze, explanations in the sciences are arguments which have a syntactic and a semantic structure—similar to that which became later known as the DN-model of explanation. The syntactic structure is delineated by ontological forms, the semantic by cosmological ones; the latter comprise the preconditions for the construction of appearances in accord with the ontological forms. Mechanisms are embedded into this logical framework by representing the more complex spatio-temporal arrangements of cosmological entities. The coordinated model of a mechanism is a reductive type of explanation. This study also demonstrates how Lotze made use of his concept of mechanisms in order to explain law-like and probabilistic events in organic and inorganic nature, thereby establishing an original ‘oligomeric’ (i. e., a fraction of the parts of a system determines its development) variant of a preformative theory of ontogenesis which anticipates modern concepts of genetic determination. In this context, Lotze alludes to paradigms of dissipative structures. The relevance of these reflections for subsequent theories is shown by contrasting them with Schrödinger’s theory of organisms. Finally, a comparison of some aspects of Lotze’s concept of mechanisms with equivalent aspects of current normative approaches confirms that essential elements of the latter versions can be retrieved in the former one. Above that, Lotze employs the teleological aspect of ontological forms in order to determine the extent of the mechanistic system under consideration. He further differentiates three modal states of mechanisms and includes a concept to explain exceptions or irregularities. The concept of ‘activity’ is strictly excluded from his account and shown to be a metaphysical illusion.     

Burn-out

At first the concept of burnout will be critically reflected in the context of the discussion in a position paper of the German Society for Psychiatry Psychotherapy and Neurology. An investigation of preventive stress management interventions at the workplace will be reported. The treatment concept of the day clinic of the Department for Psychosomatic Medicine and Psychotherapy of the Munich-Harlaching hospital for occupational stress-related disorders will be presented. An empirical study of the effectiveness of this treatment will be reported comparing patients with occupational stress-related disorders (n?=?95) to other patients treated in the day clinic during the same time interval (n?=?154). Furthermore, a qualitative analysis of 102 patient charts with occupational stress-related disorders will be described. Two case histories typical for mental health disease with burnout syndrome are presented to illustrate the conclusions.