Research Interests: Psychology, Psychophysiology, Electrophysiology, Signal Processing, Schizophrenia, and 15 moreElectroencephalography, Medicine, Biological Sciences, Humans, Thalamus, Female, Male, Somatosensory Evoked Potentials, Somatosensory Cortex, Middle Aged, Adult, Neural pathways, Median Nerve, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Philosophy and Springer
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The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief... more
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essentialism, and stigma.
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In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions... more
In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning psychiatric epistemology and practice. Taking a conceptual history approach, this essay examines how "schizophrenia" is represented in psychiatric discourse and what aspects of its representation account for the pars pro toto status. Three such aspects are identified: a pragmatic, an existential and a justificatory aspect. Following up these aspects in present day psychiatric discourse, it is concluded that "schizophrenia" is losing its special status as the representations of psychiatry and of mental illness have changed and become more diverse. Tentative conclusions regarding current debates about the abolition of "schizophrenia" are drawn.
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Psychiatry has always been characterised by highly heterogeneous theoretical concepts regarding the etiology, diagnosis and treatment of mental disorders, but also concerning the appropriate scientific methods to be applied. A central... more
Psychiatry has always been characterised by highly heterogeneous theoretical concepts regarding the etiology, diagnosis and treatment of mental disorders, but also concerning the appropriate scientific methods to be applied. A central issue is the question whether mental phenomena should preferably be explained (as in natural sciences), understood or interpreted (as in «Geisteswissenschaften») or described (with as few theoretical presuppositions as possible). This paper illustrates the main historical and actual arguments in this debate. The first conclusion is that no clear separation line exists between these three methods and that such a separation is not at all necessary for clinical or research purposes. What is needed, however, is a balanced combination of approaches, depending on the clinical or scientific questions to be answered. The second conclusion suggests a future strengthening of the role of psychopathology, a scientific field that clearly reaches beyond the reliable...
This chapter situates privacy and confidentiality as central ethical, legal, and anthropological concepts for psychotherapeutic practice. It first provides some conceptual background and clarification of the concepts before considering... more
This chapter situates privacy and confidentiality as central ethical, legal, and anthropological concepts for psychotherapeutic practice. It first provides some conceptual background and clarification of the concepts before considering their specific relevance in the context of psychotherapy. In particular, it explores a unique significance that, it is argued, privacy and confidentiality acquire in the therapeutic process to do with the anthropological dimension of privacy, its psychological function, and the specific dynamics of the therapeutic relationship. Based on four case vignettes, potential ethical conflicts about privacy and confidentiality are then discussed. Finally, principles that can guide practitioners in responding to ethical conflicts about privacy and confidentiality in clinical practice are provided.
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief... more
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essent...
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Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as... more
Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as for systematic study, others have critiqued psychiatric diagnosis for being modeled on a medical conception of disease that is ill-suited to the specific nature of mental disorders. Based on a review of seminal positions in the conceptual history of psychiatry and an examination of their epistemological underpinnings, we propose to consider diagnosis as dialogue. Such understanding, we argue, can serve as a meta-framework that provides a conceptual and practical umbrella to encourage open-minded conversation across the diverse conceptual and experiential frameworks that are characteristic of psychiatry. In this perspective psychopathology will also reinforce the interpersonal realm as a necessary element of any clinical encounter, be it diagnostic in...
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In daily clinical work, coercion continues to be highly prevalent, with rates differing between countries and sometimes even within countries or between wards of the same hospital. Previous research found inconsistent characteristics of... more
In daily clinical work, coercion continues to be highly prevalent, with rates differing between countries and sometimes even within countries or between wards of the same hospital. Previous research found inconsistent characteristics of individuals who underwent coercive measures during psychiatric treatment. Furthermore, there continues to be a lack of knowledge on the clinical course of people after being involuntarily committed. This study aimed to describe the rate and duration of different coercive measures and characterise a cohort of involuntarily committed patients regarding sociodemographic and clinical variables. In this observational cohort study, we analysed clinical data from the patients' medical files, the use of coercive measures (seclusion, restraint, coercive medication) and other procedural aspects in involuntarily hospitalised patients (n = 612) at the University Hospital of Psychiatry Zurich. For analysis, we used cross-tabulation with chi-square tests for c...
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Although knowledge about negative effects of coercive measures in psychiatry exists, its prevalence is still high in clinical routine. This study aimed at define risk factors and test machine learning algorithms for their accuracy in the... more
Although knowledge about negative effects of coercive measures in psychiatry exists, its prevalence is still high in clinical routine. This study aimed at define risk factors and test machine learning algorithms for their accuracy in the prediction of the risk to being subjected to coercive measures. In a sample of involuntarily hospitalized patients ( = 393) at the University Hospital of Psychiatry Zurich, we analyzed risk factors for the experience of coercion ( = 170 patients) using chi-square tests and Mann Whitney U tests. We trained machine learning algorithms [logistic regression, Supported Vector Machine (SVM), and decision trees] with these risk factors and tested obtained models for their accuracy via five-fold cross validation. To verify the results we compared them to binary logistic regression. In a model with 8 risk-factors which were available at admission, the SVM algorithm identified 102 out of 170 patients, which had experienced coercion and 174 out of 223 patients...
Research Interests: Psychology and Medicine
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... Paul Hoff und Anastasia Theodoridou ... Eine herausragende Erscheinung in diesem Zusammenhang, Wilhelm Griesinger, forderte nachhaltig, die klinische Psychiatrie habe sich dem psychophysischen Problem empirisch und nicht metaphysisch... more
... Paul Hoff und Anastasia Theodoridou ... Eine herausragende Erscheinung in diesem Zusammenhang, Wilhelm Griesinger, forderte nachhaltig, die klinische Psychiatrie habe sich dem psychophysischen Problem empirisch und nicht metaphysisch zu stellen, sie habe also ...
Research Interests: Genetics, Psychology, Cognitive Science, Neuroimaging, Magnetic Resonance Imaging, and 12 morePsychopathology, Electroencephalography, Medicine, Protein Structure and Function, Humans, Female, Young Adult, Fabry Disease, Clinical Sciences, Psychotic Disorders, Magnetic resonance image, and Neuropsychological Tests
Research Interests: Psychology, Cognitive Science, Psychometrics, Psychopathology, Medicine, and 15 moreMental Illness, Humans, Effect size, Female, Male, Health of the Nation Outcome Scales HoNOS, Mental Disorders, Mental Disorder, Clinical Sciences, Aged, Middle Aged, Adult, Inpatients, Psychiatric Status Rating Scales, and Outcome measure
Research Interests: Vocational Rehabilitation, Humans, Female, Male, Young Adult, and 14 moreSwitzerland, Assisted living facilities, Mental Disorders, Mental health services, Length of Stay, Clinical Sciences, Middle Aged, Adult, Retrospective Studies, Cost Savings, Cohort Studies, Halfway Houses, Combined Modality Therapy, and Health Services Accessibility
1. One aspect of using MAO-inhibitors - combining them with tricyclic antidepressants in the treatment of therapy resistant depression - has always been controversely discussed in regard to its unusual toxicity and efficacy. 2. To obtain... more
1. One aspect of using MAO-inhibitors - combining them with tricyclic antidepressants in the treatment of therapy resistant depression - has always been controversely discussed in regard to its unusual toxicity and efficacy. 2. To obtain detailled information about safety and efficacy of such a combined treatment, the charts of 94 inpatients treated with a tranylcypromine - tri- (tetra) cyclic antidepressant combination were reviewed. 3. Within a mean treatment period of 21.9 days, 68% of the patients demonstrated a very good or good improvement to combined treatment, the most effective combination being tranylcypromine + amitriptyline. 4. The incidence of side effects among the patients on the combined regimen was slightly, but not significantly lower as compared to the patients on single tri- (tetra) cyclic antidepressant treatment. 5. Our retrospective study supports the general safety and efficacy of combined MAOI-TCA treatment and suggests that combined treatment, if properly administered, leads to neither serious complications nor an inordinate number of side effects.
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Probably few psychiatrists would spontaneously associate Emil Kraepelin’s name with philosophy. Nevertheless, I think it is necessary to look at this relationship for the following reasons: During recent years, several authors have... more
Probably few psychiatrists would spontaneously associate Emil Kraepelin’s name with philosophy. Nevertheless, I think it is necessary to look at this relationship for the following reasons: During recent years, several authors have described a crisis in psychiatry, particularly in psychiatric diagnosis. It is not purely coincidental that in such a “critical” era, many concepts and ideas are “re-discovered” which previously have been regarded as of merely historical interest. This is especially true of Emil Kraepelin’s psychiatry. The influence of what is often called the “neo-Kraepelinian movement” is well-known, an influence which manifests itself, for example, in the operationalized diagnostic criteria of DSM-III-R, and which proves the profound relevance of Kraepelinian ideas for present-day psychiatry (Blashfield 1984). Given this situation, it seems appropriate to critically reevaluate Kraepelin’s nosological positions as they changed over time (which cannot be further discussed here), and—our present topic—to highlight the philosophical implications of this nosology, although—as will be shown—they often are quite well hidden.1
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ABSTRACT
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Emil Kraepelin (1856-1926) was an influential figure in the history of psychiatry as a clinical science. This paper, after briefly presenting his biography, discusses the conceptual foundations of his concept of mental illness and follows... more
Emil Kraepelin (1856-1926) was an influential figure in the history of psychiatry as a clinical science. This paper, after briefly presenting his biography, discusses the conceptual foundations of his concept of mental illness and follows this line of thought through to late 20th-century "Neo-Kraepelinianism," including recent criticism, particularly of the nosological dichotomy of endogenous psychoses. Throughout his professional life, Kraepelin put emphasis on establishing psychiatry as a clinical science with a strong empirical background. He preferred pragmatic attitudes and arguments, thus underestimating the philosophical presuppositions of his work. As for nosology, his central hypothesis is the existence and scientific accessibility of "natural disease entities" ("natürliche Krankheitseinheiten") in psychiatry. Notwithstanding contemporary criticism that he commented upon, this concept stayed at the very center of Kraepelin's thinking, and t...
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The history of psychiatric medicine is punctuated with what can be considered to be breakthrough moments, times at which an individual speaks out against the shameful way
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In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning... more
In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning psychiatric epistemology and practice. Taking a conceptual history approach, this essay examines how "schizophrenia" is represented in psychiatric discourse and what aspects of its representation account for the pars pro toto status. Three such aspects are identified: a pragmatic, an existential and a justificatory aspect. Following up these aspects in present day psychiatric discourse, it is concluded that "schizophrenia" is losing its special status as the representations of psychiatry and of mental illness have changed and become more diverse. Tentative conclusions regarding current debates about the abolition of "schizophrenia" are drawn.
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Die Fallschilderung beeindruckt aus zwei Gründen: (1) Sie adressiert in authentischer Weise das schwierige Gebiet medizinischer Zwangsmaßnahmen, speziell bei der Behandlung psychischer Erkrankungen. (2) Das persönliche Engagement der... more
Die Fallschilderung beeindruckt aus zwei Gründen: (1) Sie adressiert in authentischer Weise das schwierige Gebiet medizinischer Zwangsmaßnahmen, speziell bei der Behandlung psychischer Erkrankungen. (2) Das persönliche Engagement der Autorin wird deutlich spürbar, hat sie doch die 19-jährige (und damit gleichaltrige) Patientin über Monate erlebt, teils selbst in der Rolle der „1:1-Betreuerin“. Als im akutpsychiatrischen Bereich tätiger Psychiater und Psychotherapeut möchte ich auf vier thematische Facetten eingehen.
Die sorgfaltige Anamneseerhebung ist Voraussetzung, ja sogar integraler Bestandteil jeder psychiatrisch-psychotherapeutischen Diagnostik und Therapie. Die hier vorgestellte Systematik spricht die wesentlichen Bereiche an; im Interesse... more
Die sorgfaltige Anamneseerhebung ist Voraussetzung, ja sogar integraler Bestandteil jeder psychiatrisch-psychotherapeutischen Diagnostik und Therapie. Die hier vorgestellte Systematik spricht die wesentlichen Bereiche an; im Interesse einer moglichst vollstandigen Datenerhebung empfiehlt sich die konsequente Anwendung eines derartigen Schemas. Jenseits dieses formalen Aspekts kommt es aber entscheidend darauf an, die Balance zu halten zwischen umfassender Datensammlung auf der einen und Respekt vor der Individualitat und Intimitat des Patienten auf der anderen Seite. Hier wird jeder Untersucher mit wachsender Erfahrung einen eigenen „Stil“ entwickeln mussen. Dies steht keineswegs im Gegensatz zu einem strukturierten Vorgehen. Im Gegenteil: Erst die personliche Ausgestaltung der vorgegebenen Struktur stellt die dem individuellen Patienten angemessene und damit respektvolle Weise der Anamneseerhebung dar.
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The "Association of Methodology and Documentation in Psychiatry" (AMDP) has developed the 2nd version of a new observer-rated scale for a quick and precise assessment of obsessive-compulsive symptoms. The first version of the... more
The "Association of Methodology and Documentation in Psychiatry" (AMDP) has developed the 2nd version of a new observer-rated scale for a quick and precise assessment of obsessive-compulsive symptoms. The first version of the scale comprised 20 items on the dimensions "description", "distress and impairment" and "emotion and cognition". The item pool of the 2. version was enlarged to 44 items to accomplish a differentiated assessment of obsessions and compulsions and to assess the associated passive avoidance behaviour. The results of an empirical study (n = 141) demonstrated excellent internal consistency (Cronbach's alpha = 0,93), a split-half reliability of 0,83 (Spearman-Brown), a test-retest reliability of r = 0,84, a high interrater-reliability, a high differential validity and good convergent validity with the Hamburger Zwangsinventar (HZI) and the SCL-90-R. The results are presented and their implications on the final steps of the development of the scale will be discussed.
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Deskriptive psychopathologische Befunderhebung – dieser Begriff meint zum einen ein methodenkritisches Vorgehen mit dem erklarten Ziel der Vermeidung impliziter theoretischer Vorannahmen. Zum anderen aber stost er seinerseits an... more
Deskriptive psychopathologische Befunderhebung – dieser Begriff meint zum einen ein methodenkritisches Vorgehen mit dem erklarten Ziel der Vermeidung impliziter theoretischer Vorannahmen. Zum anderen aber stost er seinerseits an methodische und konzeptionelle Grenzen, an die es zu denken gilt, um bei der Untersuchung und Beschreibung der abnormen psychischen Phanomene keine Vorurteile und unzulassigen Verkurzungen wirksam werden zu lassen. Der Begriff der deskriptiven Psychopathologie ist viel alter als die heute gebrauchlichen Diagnosesysteme, doch heben diese ganz wesentlich auf den von ihnen praktizierten deskriptiven Zugangsweg ab. Freilich sind operationale Diagnostik und deskriptive Psychopathologie keineswegs deckungsgleich. Ein groser Vorteil jedes deskriptiven Ansatzes liegt in der deutlich verminderten Gefahr der Verquickung ungeprufter atiopathogenetischer Hypothesen mit dem diagnostischen und therapeutischen Prozess sowie in einer hoheren Reliabilitat. Wird Deskription allerdings zu eng gefasst, etwa als eindeutiges Abbilden eines objektiven Tatbestandes beim Patienten durch ein ebenso objektives Medium, den Untersucher, so werden rasch die Nachteile deutlich, namlich das Uberwiegen der formalen zuungunsten der inhaltlichen Aspekte, die zwar unumgangliche, aber eben problematische Reduktion der klinischen Gesamtheit auf das deskriptiv Erfassbare und das Unterschatzen, ja Vernachlassigen von komplexen subjektiven Erlebensweisen, die oft die Beziehungsebene betreffen und in den Kriterienkatalogen nicht oder nur verkurzt vorkommen (konnen). Sei nun die Rede von der ursprunglichen deskriptiven Psychopathologie im Sinne Karl Jaspers’ („phanomenologische Richtung“) und Kurt Schneiders („deskriptiv-analytische Methode“) oder von den zum Teil uber sie hinausgehenden, z. T. hinter sie zuruckfallenden aktuellen operationalisierten Befunderfassungs- und Diagnosesystemen, in jedem Fall ist eine empathisch-verstehende, von Respekt getragene Grundhaltung die wesentliche Basis einer sorgfaltigen und damit patientengerechten Erhebung des psychopathologischen Befundes.
Background: Involuntary admission (IA) for psychiatric treatment has a history of controversial discussions. We aimed to describe characteristics of a cohort of involuntarily compared to voluntarily admitted patients regarding clinical... more
Background: Involuntary admission (IA) for psychiatric treatment has a history of controversial discussions. We aimed to describe characteristics of a cohort of involuntarily compared to voluntarily admitted patients regarding clinical and socio-demographic characteristics before and after implementation of the new legislation. Methods: In this observational cohort study, routine data of 15’125 patients who were admitted to the University Hospital of Psychiatry Zurich between 2008 and 2016 were analyzed using a series of generalized estimating equations. Results: At least one IA occurred in 4’560 patients (30.1%). Of the 31’508 admissions 8’843 (28.1%) were involuntary. In the final multivariable model, being a tourist (OR = 3.5) or an asylum seeker (OR = 2.3), having a schizophrenic disorder (OR = 2.1), or a bipolar disorder (OR = 1.8) contributed most to our model. Male gender, higher age, prescription of neuroleptics (all OR < 2.0) as well as having a depressive disorder, pres...
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Die Verlaufsforschung nimmt eine zentrale Stelle bei der Entwicklung und Validierung von Konzepten zur Klassifikation endogener Psychosen ein. Kahlbaum und Kraepelin postulierten fur die Vielfalt psychiatrischer Syndrome sogenannte... more
Die Verlaufsforschung nimmt eine zentrale Stelle bei der Entwicklung und Validierung von Konzepten zur Klassifikation endogener Psychosen ein. Kahlbaum und Kraepelin postulierten fur die Vielfalt psychiatrischer Syndrome sogenannte Zustands-Verlaufseinheiten, die unterschiedliche, klar voneinander abgrenzbare Krankheitsentitaten reprasentieren sollten (Kraepelin 1896). 1911 loste das von E. Bleuler entwickelte Schizophrenie-Konzept das Konzept der „praecox“ ab und gestand der Schizophrenie eine potentiell gute Prognose zu. Die in der Psychiatrie weit verbreitete Dichotomie von schizophrenen versus affektiven Storungen mit dem fur die jeweilige Storung charakteristischen Verlauf und Ausgang bestand jedoch weiterhin. Diese traditionelle, auch heute noch allgemein anerkannte Verknupfung von diagnostischer Kategorie und typischem Verlauf muβ aufgrund bisheriger Verlaufsstudien relativiert werden. Schizophrene Sturungen weisen nicht in jedem Fall ungunstige Verlaufe auf, was bereits von ...
Elliot Abemayor, MD, PhD Jason L. Acevedo, MD Eugenia Allegra, MD, PhD Jacqui E. Allen, MBChB, FRACS Petra Ambrosch, MD Vinod K. Anand, MD Jennifer Anderson, MD, FRCSC Simon I. Angeli, MD Samantha Anne, MD Jack B. Anon, MD Rony K. Aouad,... more
Elliot Abemayor, MD, PhD Jason L. Acevedo, MD Eugenia Allegra, MD, PhD Jacqui E. Allen, MBChB, FRACS Petra Ambrosch, MD Vinod K. Anand, MD Jennifer Anderson, MD, FRCSC Simon I. Angeli, MD Samantha Anne, MD Jack B. Anon, MD Rony K. Aouad, MD, FACS Oneida A. Arosarena, MD Karthik Balakrishnan, MD, MPH Donald D. Beahm, MD Joshua Bedwell, MD Mathieu Bergeron, MD, BPharm, FRCSC Simon R.A. Best, MD Brian W. Blakley, MD, PhD Jonathan M. Bock, MD Sarah N. Bowe, MD Jennings R. Boyette, MD Joseph P. Bradley, MD Michael J. Brenner, MD Scott E. Brietzke, MD, MPH Christopher D. Brook, MD Clifford S. Brown, MD J. D. Browne, MD Kevin T. Brumund, MD Nicolas Y. Busaba, MD Matthew L. Bush, MD, PhD Cristina Cabrera-Muffly, MD Trinitia Y. Cannon, MD Erika M. Celis-Aguilar, MD Mohamad R. Chaaban, MD, MSCR, MBA Raymond L. Chai, MD Philip G. Chen, MD Jeffrey Cheng, MD Neil N. Chheda, MD David H. Chi, MD Steven B. Chinn, MD, MPH Do Cho, MD Richard A. Chole, MD, PhD John D. Clinger, MD David M. Cognetti, MD...
The epistemic processes leading to a practically viable “knowledge” in psychopathology are traced back from the transcendental-philosophical premises and antecedents through various epistemic steps to the empirical recognition and... more
The epistemic processes leading to a practically viable “knowledge” in psychopathology are traced back from the transcendental-philosophical premises and antecedents through various epistemic steps to the empirical recognition and systematisation into a scientific theory. Psychopathology should serve empirical procedures in diagnostics, epidemiology, etiological conditions. However, it should also produce viable advices for the interpersonal therapeutic transaction. This is illustrated by an example of a catatonic syndrome.
Zusammenfassung Die im psychiatrischen Schrifttum bislang kaum bearbeitete Problematik der Gutachtenerstattung zur Notwendigkeit einer Sicherungsverwahrung wird an einem Fallbeispiel dargestellt und diskutiert. Des Weiteren wird ein... more
Zusammenfassung Die im psychiatrischen Schrifttum bislang kaum bearbeitete Problematik der Gutachtenerstattung zur Notwendigkeit einer Sicherungsverwahrung wird an einem Fallbeispiel dargestellt und diskutiert. Des Weiteren wird ein Procedere vorgeschlagen, das im Anschluss an die psychopathologische und an der klinischen Empirie ausgerichtete Prüfung der Schuldfähigkeit sozialpsychologische bzw. kriminologische Ansätze integriert, um Aussagen zur Hangtäterschaft treffen zu können.
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Eine mit der aktuellen klinischen und wissenschaftlichen Praxis verbundene psychiatriehistorische Forschung, die sich mit Begriffen, Personen und Institutionen beschaftigt, ist unabdingbar. Dies gilt insbesondere in Zeiten, in denen – wie... more
Eine mit der aktuellen klinischen und wissenschaftlichen Praxis verbundene psychiatriehistorische Forschung, die sich mit Begriffen, Personen und Institutionen beschaftigt, ist unabdingbar. Dies gilt insbesondere in Zeiten, in denen – wie heute – die Frage nach der Identitat des Fachs Psychiatrie haufiger und kritischer gestellt wird.
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The paper comments the German legal and forensic-psychiatric positions regarding the complex and yet unsolved question of insight in the context of criminal responsibility. Possible restrictions of insight are discussed. Finally a... more
The paper comments the German legal and forensic-psychiatric positions regarding the complex and yet unsolved question of insight in the context of criminal responsibility. Possible restrictions of insight are discussed. Finally a solution is suggested, which connects the assessment of insight with the ability to declare a free will: Both terms deal with the predecisional cognitive and motivational foundation of acts. Insight is closely associated with the competence to constitute a free will. Symptoms and disorders which tend to disturb this ability can be assessed by psychopathological methods. Possible restrictions concern mental retardation, dementia, organic personality disorders, mental disorders with delusional ideation and residual states of schizophrenia.
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This paper links the historical perspective with the actual debate on the concept of schizophrenia. By this, two aims shall be accomplished. First, to prove that Eugen Bleuler’s (1857–1939) concept of ‘schizophrenia’ in its central parts... more
This paper links the historical perspective with the actual debate on the concept of schizophrenia. By this, two aims shall be accomplished. First, to prove that Eugen Bleuler’s (1857–1939) concept of ‘schizophrenia’ in its central parts was a clear step forward, as compared to previous approaches, especially the notion of ‘dementia praecox’, proposed and favored by French authors like Bénédict
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Summary This paper addresses two major concepts of psychoses, those developed by Emil Kraepelin (1856 –1926) and Eugen Bleuler (1857–1939). Kraepelin’s nosology aimed at detecting “natural disease entities" and represented, by its... more
Summary This paper addresses two major concepts of psychoses, those developed by Emil Kraepelin (1856 –1926) and Eugen Bleuler (1857–1939). Kraepelin’s nosology aimed at detecting “natural disease entities" and represented, by its concept of “dementia praecox", a clinical approach strongly oriented on the course of illness, which led to a pessimistic view on prognosis and created a “narrow" concept of severe
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Reading this collection brings to mind the words of the melancholic Jacques in As you like it because the 'cultural performances' of its title include virtually anything on the whole world's stage: the musical and poetic... more
Reading this collection brings to mind the words of the melancholic Jacques in As you like it because the 'cultural performances' of its title include virtually anything on the whole world's stage: the musical and poetic performances of recited or sung texts, the visual presentation of texts on the page, the design and use of artefacts (ivory reliefs and silk alms purses), and even the performance of 'the vice of pride in the theater of society'(p. 197). Shakespeare's text works at the level of an extended metaphor, which is effectively how the various ' ...
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Zusammenfassung. Das Erleben der eigenen Körperlichkeit ist ein zentraler Aspekt der Conditio humana. Bei psychischen Krisen und Erkrankungen kann es erheblich bis massiv beeinträchtigt werden. Der Beitrag erläutert dies an klinischen... more
Zusammenfassung. Das Erleben der eigenen Körperlichkeit ist ein zentraler Aspekt der Conditio humana. Bei psychischen Krisen und Erkrankungen kann es erheblich bis massiv beeinträchtigt werden. Der Beitrag erläutert dies an klinischen Beispielen und arbeitet Bedingungen für den Aufbau tragfähiger therapeutischer Beziehungen im Umgang mit dieser Patientengruppe heraus.
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Reification is the assumption that mental illnesses exist independent of the observer’s conceptualization. The present debate usually addresses naturalistic reification, i.e., the definition of mental illness as an empirically detectable... more
Reification is the assumption that mental illnesses exist independent of the observer’s conceptualization. The present debate usually addresses naturalistic reification, i.e., the definition of mental illness as an empirically detectable neurobiological dysfunction. This chapter discusses Kraepelin’s and Bleuler’s views on nosology and the position of current operationalized diagnoses (DSM-5, ICD-10), delineating recent debate on the relevance of new research technologies.There are two main conclusions: (1) “Mental illness” always refers to a concept, not to a given thing. This does not reduce the scientific value of neurobiological research: If subjective and interpersonal phenomena are acknowledged although they do not fit into a strictly naturalistic framework, sound neurobiological research will be promoted, not hampered. (2) Diagnostic and therapeutic processes in psychiatry require human interaction, so any model of mental illness must address interpersonality. Recent phenomen...
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Abstract The present-day scientific literature on fundamental issues in psychiatry and psychopathology centers around the following topics: scientific status of psychiatry, especially in comparison with other fields of medicine; basic... more
Abstract The present-day scientific literature on fundamental issues in psychiatry and psychopathology centers around the following topics: scientific status of psychiatry, especially in comparison with other fields of medicine; basic problems of psychiatric ...
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Abstract 1. Discusses 3 papers from 1918 to 1920 that help toward an understanding of E. Kraepelin's view of psychiatry as a science. P. Hoff focuses on 3 conceptual stands from Kraepelin's 1920 paper:(1) philosophy in terms of... more
Abstract 1. Discusses 3 papers from 1918 to 1920 that help toward an understanding of E. Kraepelin's view of psychiatry as a science. P. Hoff focuses on 3 conceptual stands from Kraepelin's 1920 paper:(1) philosophy in terms of realism, empiricism, and parallelism;(2) ...
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The present study reports results of the ICD-10 research criteria trial concerning the diagnosis of affective disorders (section F3). On the basis of written case reports and videotapes a total of 451 clinicians from 34 centres in... more
The present study reports results of the ICD-10 research criteria trial concerning the diagnosis of affective disorders (section F3). On the basis of written case reports and videotapes a total of 451 clinicians from 34 centres in German-speaking countries prepared 2.228 diagnostic ratings on 39 different psychiatric patients. Three of the 39 cases met the diagnostic criteria for affective disorders, and 248 of the diagnostic assessments referred to these cases. The majority of clinicians rated the reliability, the ease and the suitability of the diagnostic criteria positively. The reliability of the affective disorders was extremely good, with a kappa of 0.93 in the range of 2-character diagnoses. The reliability of the 3-character categories was much smaller: Kappa values for depressive episode (F31) and recurrent depressive disorder (F33) were 0.68 and 0.54, respectively. The lowest concordance had a kappa value of 0.22 and was found in the case report of dysthymia (F34.1). Therefore a more precise definition of the diagnostic criteria for dysthymia would be desirable.
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Psychopathology is usually recognized as an important clinical and research tool in psychiatric textbooks. However, in the era of operationalized psychiatric diagnosis, therapeutic guidelines and strong neuroscientific impact on the... more
Psychopathology is usually recognized as an important clinical and research tool in psychiatric textbooks. However, in the era of operationalized psychiatric diagnosis, therapeutic guidelines and strong neuroscientific impact on the self-understanding of psychiatry, its role became somewhat insecure in recent decades. And it has even been argued that psychopathology will sooner or later be fully replaced by neuroscientific concepts. This paper elucidates the theoretical (and, partly, historical) framework of this debate and argues for a modern understanding of psychopathology. This understanding will, on the one hand, be compatible with neurobiological and social sciences appoaches to mental illness, and, on the other hand, will not abandon psychopathology&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s demand to be an indispensable foundation of psychiatry.
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War es früher für systematische psychiatrische Darstellungen auch und gerade mit Blick auf forensische Fragen selbstverständlich, dass psychopathologische Aspekte einen zentralen Stellenwert erhalten, so ist dies heute nicht mehr der... more
War es früher für systematische psychiatrische Darstellungen auch und gerade mit Blick auf forensische Fragen selbstverständlich, dass psychopathologische Aspekte einen zentralen Stellenwert erhalten, so ist dies heute nicht mehr der Fall. Die Psychopathologie ist in der psychiatrischen Forschung und Klinik des 21. Jahrhunderts keineswegs mehr unumstritten. Kritische Stimmen haben eingewandt, dass eine rein beschreibende Psychopathologie spätestens Mitte des 20. Jahrhunderts mit dem Werk von Kurt Schneider, dem Heidelberger Psychiater, an einen Endpunkt gelangt sei. Durch replizierende Beschreibung sei in Zukunft nichts Neues mehr zu erwarten. Insofern könne die Psychopathologie nur schwerlich eine inhaltliche Richtschnur für die psychiatrische Forschung auch mit Blick auf forensische Fragestellungen abgeben.
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Abstract 1. Discusses 3 papers from 1918 to 1920 that help toward an understanding of E. Kraepelin's view of psychiatry as a science. P. Hoff focuses on 3 conceptual stands from Kraepelin's 1920 paper:(1) philosophy in terms of... more
Abstract 1. Discusses 3 papers from 1918 to 1920 that help toward an understanding of E. Kraepelin's view of psychiatry as a science. P. Hoff focuses on 3 conceptual stands from Kraepelin's 1920 paper:(1) philosophy in terms of realism, empiricism, and parallelism;(2) ...
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... DISKUSSIONEN - Das psychiatrische Sachverständigengutachten zur Hangtäterschaft. Zumutung oder Herausforderung? Autores: Elmar Habermeyer, Henning Sass, Paul Hoff; Localización: Monatsschrift für kriminologie und strafrecht, ISSN... more
... DISKUSSIONEN - Das psychiatrische Sachverständigengutachten zur Hangtäterschaft. Zumutung oder Herausforderung? Autores: Elmar Habermeyer, Henning Sass, Paul Hoff; Localización: Monatsschrift für kriminologie und strafrecht, ISSN 0026-9301, Vol. ...
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Oral squamous cell cancer (OSCC) is often diagnosed in late stages. Informative biomarkers could play a key role in early diagnosis. Prior case-control studies identified discriminatory salivary mRNA markers for OSCC. The National Cancer... more
Oral squamous cell cancer (OSCC) is often diagnosed in late stages. Informative biomarkers could play a key role in early diagnosis. Prior case-control studies identified discriminatory salivary mRNA markers for OSCC. The National Cancer Institute (NCI) recommends prospective-specimencollection, retrospective-blinded-evaluation (PRoBE) design study for rigorous biomarker identification and validation. A PRoBE design study enrolled 170 patients with lesions suspicious for OSCC. Saliva was collected before performing oral biopsy. Six pre-specified oral-cancer-associated mRNAs (IL1β, IL8, OAZ1, SAT, S100P, and DUSP1) and five housekeeping mRNAs (MT-ATP6, RPL30, RPL37A, RPL0, and RPS17) were measured by quantitative polymerase chain reaction (PCR) without knowledge of tissue diagnosis. A pre-specified multi-marker panel from prior NCI - Early Detection Research Network (EDRN) studies was evaluated in this new PRoBE dataset. Individual marker cycle thresholds (Ct) from PCR were also comp...
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Of all medical specialities, psychiatry and psychotherapy are probably the ones that are most intensively connected with political, historical and social developments taking place in society [1]. However, the relationship between... more
Of all medical specialities, psychiatry and psychotherapy are probably the ones that are most intensively connected with political, historical and social developments taking place in society [1]. However, the relationship between psychiatry and society is typically an ambivalent ...
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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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This review focuses on publications dealing with psychiatrists&amp;amp;amp;amp;#39; biographies. Compared with scientific mainstream topics in psychiatry, the present area constitutes a small but nonetheless highly heterogeneous... more
This review focuses on publications dealing with psychiatrists&amp;amp;amp;amp;#39; biographies. Compared with scientific mainstream topics in psychiatry, the present area constitutes a small but nonetheless highly heterogeneous field. The selected papers are categorized with regard to what relevance is given to biographical data in a narrow sense or to conceptual issues for which the biography of a certain author functions as an illustration. Mere hagiographic biographical notes were not taken into consideration, and nor were plain polemics. Although the differentiation mentioned above seems useful in order to get an overview, it is de facto not possible to clearly separate biographical from conceptual aspects. This may be true for all fields in the history of science, but it is definitely true in the history of psychiatry with its numerous long-standing theoretical controversies - many of them still unresolved and all of them closely linked with the lives of their prominent representatives. The biographical approach can be helpful in proving that research on the history of psychiatry--if done beyond mere hagiography or simple polemic--is of crucial importance for the understanding and development of theoretical and practical issues in our field.
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With Michael Billington, theatre critic, the Guardian
Emil Kraepelin (1856-1926) was an influential figure in the history of psychiatry as a clinical science. This paper, after briefly presenting his biography, discusses the conceptual foundations of his concept of mental illness and follows... more
Emil Kraepelin (1856-1926) was an influential figure in the history of psychiatry as a clinical science. This paper, after briefly presenting his biography, discusses the conceptual foundations of his concept of mental illness and follows this line of thought through to late 20th-century "Neo-Kraepelinianism," including recent criticism, particularly of the nosological dichotomy of endogenous psychoses. Throughout his professional life, Kraepelin put emphasis on establishing psychiatry as a clinical science with a strong empirical background. He preferred pragmatic attitudes and arguments, thus underestimating the philosophical presuppositions of his work. As for nosology, his central hypothesis is the existence and scientific accessibility of "natural disease entities" ("natürliche Krankheitseinheiten") in psychiatry. Notwithstanding contemporary criticism that he commented upon, this concept stayed at the very center of Kraepelin's thinking, and t...
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This paper discusses the phenomenon of suicidality with regard to patient autonomy on the one hand and the obligation of medical professionals to provide support and treatment on the other hand. The continuation of a broad debate on these... more
This paper discusses the phenomenon of suicidality with regard to patient autonomy on the one hand and the obligation of medical professionals to provide support and treatment on the other hand. The continuation of a broad debate on these issues within the whole of society is mandatory also in the future. Suicide and assisted suicide are topics with high relevance for medicine in general and for psychiatry in particular. They can, however, not be handled by medical specialists alone.
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The issue of personality disorders addresses fundamental questions of psychiatry: Is there a clear boundary between normal behaviour and the state of mental illness? Which criteria are defining this boundary? Is a personality disorder... more
The issue of personality disorders addresses fundamental questions of psychiatry: Is there a clear boundary between normal behaviour and the state of mental illness? Which criteria are defining this boundary? Is a personality disorder really a mental illness or «just» a special variation of an individual lifestyle? This paper reviews the development of the terms psychopathy/personality disorder from the early 19th century to the present-day diagnostic manuals ICD-10 and DSM-5. This debate spreads out–as it does with regard to any other mental disorder–between psychopathological, neurobiological and social sciences approaches. It is of high practical relevance to realize that nowadays effective therapeutic options for patients with personality disorders are available. Therefore, the therapeutic nihilism of earlier times is no longer justified.
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Abstract Theoretical papers on the nature of psychiatry and its position amongst the medical specialities are increasing in number and quality. Authors seem in need of two strategies: on the one hand to avoid simplifying and dichotomizing... more
Abstract Theoretical papers on the nature of psychiatry and its position amongst the medical specialities are increasing in number and quality. Authors seem in need of two strategies: on the one hand to avoid simplifying and dichotomizing psychiatric concepts into'good'and' ...
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Pimobendan (UD-CG 115 BS; 4,5-dihydro-6-[2-(4-methoxyphenyl)-1H-benzimidazol-5-yl]-5-methyl- 3(2H)- pyridazinone) is a newly developed, structurally novel compound with positive inotropic as well as coronary and peripheral vasodilator... more
Pimobendan (UD-CG 115 BS; 4,5-dihydro-6-[2-(4-methoxyphenyl)-1H-benzimidazol-5-yl]-5-methyl- 3(2H)- pyridazinone) is a newly developed, structurally novel compound with positive inotropic as well as coronary and peripheral vasodilator activities. In vitro, pimobendan has been reported to prolong the duration of the cardiac action potential of ventricular myocardial tissue, suggesting the potential for this agent to increase myocardial refractoriness and possibly exert antiarrhythmic activity in vivo. In the present study, the effects of pimobendan upon cardiac electrophysiologic parameters, the induction of ventricular tachycardia by programmed ventricular stimulation, and upon the development of ischemic ventricular fibrillation were assessed in 16 conscious dogs 3 to 5 days after experimental anterior myocardial infarction. The intravenous administration of 0.3 mg/kg pimobendan to postinfarction dogs significantly reduced the rate-corrected QTc and paced QT intervals, and reduced the relative and effective refractory periods in normal noninjured ventricular myocardium. Electrophysiologic parameters in infarcted ventricular myocardium were not altered by pimobendan. Ventricular tachycardia remained inducible early after anterior myocardial infarction in eight of eight pimobendan-treated postinfarction dogs tested. Six of the eight pimobendan-treated animals that had nonsustained tachyarrhythmias elicited as initial responses to baseline programmed stimulation testing had sustained tachycardias induced at postdrug testing, with a reduction in the number of programmed extrastimuli required to induce the postpimobendan tachyarrhythmias occurring in three animals.(ABSTRACT TRUNCATED AT 250 WORDS)
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With the introduction of operationalized diagnostic systems the multiaxial approach became a more important issue. The proposed multiaxial system of ICD-10 consists of three axes: on axis I psychiatric diagnoses are made according to the... more
With the introduction of operationalized diagnostic systems the multiaxial approach became a more important issue. The proposed multiaxial system of ICD-10 consists of three axes: on axis I psychiatric diagnoses are made according to the ICD-10 Clinical Guidelines or Diagnostic Criteria for Research. Axis II (Disability Diagnostic Scale, DDS) deals with impairment of psychosocial functioning. On axis III environmental/circumstantial and personal lifestyle management factors are rated. As part of the WHO international field trial, applicability and inter-rater reliability of the system were examined in seven German-speaking centers. In addition axis II was compared with the corresponding axis of DSM-III-R (Global Assessment of Functioning Scale). 45 German clinicians rated 12 case histories written in English (provided by WHO) with 488 ratings altogether. Diagnoses on axis I with an average percentage agreement of 65.6% and a mean kappa of 0.50 showed a moderate inter-rater reliability. For axis II the intraclass coefficient was 0.62, and that for the corresponding DSM-III axis was 0.65: both these axes thus also had a moderate inter-rater reliability. There was a close correlation between the subscales and the global assessment of axis II there was. Wide variation was found in the psychosocial circumstances on axis III, the mean kappa value being 0.16. In the discussion proposals for the revision process for the multiaxial ICD-10 system are made.
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As compared to other tri- and tetracyclics, antidepressant therapy in patients suffering also from cardiac disease with mianserin is known to be relatively safe. Hypertensive effects of mianserin have not been described so far. We report... more
As compared to other tri- and tetracyclics, antidepressant therapy in patients suffering also from cardiac disease with mianserin is known to be relatively safe. Hypertensive effects of mianserin have not been described so far. We report a case of 64 years old patient with a dilatative cardiomyopathy and left anterior hemiblock, who developed hypertension (maximum: 180/125 mmHg) during mianserin treatment. Previous treatment with tranylcypromine has been stopped two weeks before. After discontinuance of mianserin blood pressure rapidly came back to normal values. The possible noradrenergic and serotonergic mechanisms of this phenomenon are discussed in relation to pretreatment with tranylcypromine.
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Delusion as a phenomenon was always in the focus of psychiatric interest. Explanations for its origin reach from disturbed perception or affect to deficits in cognition. In our study we investigated 20 deluded, 20 depressive and 20... more
Delusion as a phenomenon was always in the focus of psychiatric interest. Explanations for its origin reach from disturbed perception or affect to deficits in cognition. In our study we investigated 20 deluded, 20 depressive and 20 healthy subjects in order to find out differences in decision making, while a neutral test situation. Our hypothesis was that deluded subjects need less information for decision making and tend less to change their decision, made before, than both control groups will do this. For examination our hypothesis a modified version of &quot;Probabilistic Inference Task&quot; by Philips and Edwards was performed. In summary we found that deluded subjects need less information for decisions making than the control groups. Furthermore, decision making of deluded subjects seems more impulsive and less referring to formal logical criteria than it was found in depressed and healthy volunteers.
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Psychotic illness recurred in a 25-year-old manic-depressive woman during anti-infertility treatment with clomiphene citrate. The symptoms of this episode (disturbance of consciousness, psychomotoric abnormalities, paranoid-hallucinatory... more
Psychotic illness recurred in a 25-year-old manic-depressive woman during anti-infertility treatment with clomiphene citrate. The symptoms of this episode (disturbance of consciousness, psychomotoric abnormalities, paranoid-hallucinatory syndrome with transient neurological dysfunctions) differed significantly from previous and subsequent psychotic patterns. No organic cause other than treatment with clomiphene could be discovered despite intensive diagnostic efforts. The pathogenetic role of clomiphene is supported by comparable findings in certain post-partum psychoses. Women with a history of psychiatric disorders are especially at risk.
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The present study reports results of the ICD-10 research criteria trial concerning the diagnosis of affective disorders (section F3). On the basis of written case reports and videotapes a total of 451 clinicians from 34 centres in... more
The present study reports results of the ICD-10 research criteria trial concerning the diagnosis of affective disorders (section F3). On the basis of written case reports and videotapes a total of 451 clinicians from 34 centres in German-speaking countries prepared 2.228 diagnostic ratings on 39 different psychiatric patients. Three of the 39 cases met the diagnostic criteria for affective disorders, and 248 of the diagnostic assessments referred to these cases. The majority of clinicians rated the reliability, the ease and the suitability of the diagnostic criteria positively. The reliability of the affective disorders was extremely good, with a kappa of 0.93 in the range of 2-character diagnoses. The reliability of the 3-character categories was much smaller: Kappa values for depressive episode (F31) and recurrent depressive disorder (F33) were 0.68 and 0.54, respectively. The lowest concordance had a kappa value of 0.22 and was found in the case report of dysthymia (F34.1). Therefore a more precise definition of the diagnostic criteria for dysthymia would be desirable.
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In routine clinical work, the psychopathology of some patients makes distinct diagnosis more difficult for the psychiatrist. In schizophrenia, especially those patients with dominant autism, eccentric behaviour, and abnormalities of... more
In routine clinical work, the psychopathology of some patients makes distinct diagnosis more difficult for the psychiatrist. In schizophrenia, especially those patients with dominant autism, eccentric behaviour, and abnormalities of affect with no evidence of positive symptoms pose special diagnostic problems. We report a case with formal thought disorder, autism, altered interactional behaviour, and disturbed emotional expression with no characteristic schizophrenic perception disorders, delusions, or other positive symptoms. With the help of this exemplary case, we discuss the diagnostic dilemma in careful use of diagnostic criteria in diagnosing schizophrenia in such cases.
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The &quot;Association of Methodology and Documentation in Psychiatry&quot; (AMDP) has developed the 2nd version of a new observer-rated scale for a quick and precise assessment of obsessive-compulsive symptoms. The first version... more
The &quot;Association of Methodology and Documentation in Psychiatry&quot; (AMDP) has developed the 2nd version of a new observer-rated scale for a quick and precise assessment of obsessive-compulsive symptoms. The first version of the scale comprised 20 items on the dimensions &quot;description&quot;, &quot;distress and impairment&quot; and &quot;emotion and cognition&quot;. The item pool of the 2. version was enlarged to 44 items to accomplish a differentiated assessment of obsessions and compulsions and to assess the associated passive avoidance behaviour. The results of an empirical study (n = 141) demonstrated excellent internal consistency (Cronbach&#39;s alpha = 0,93), a split-half reliability of 0,83 (Spearman-Brown), a test-retest reliability of r = 0,84, a high interrater-reliability, a high differential validity and good convergent validity with the Hamburger Zwangsinventar (HZI) and the SCL-90-R. The results are presented and their implications on the final steps of the development of the scale will be discussed.
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Due to legal regulations, external quality assurance is mandatory in Germany. Supported by the German Health Ministry (BMG), we present the results of a multicenter study in four hospitals with different structures on 1042 inpatients with... more
Due to legal regulations, external quality assurance is mandatory in Germany. Supported by the German Health Ministry (BMG), we present the results of a multicenter study in four hospitals with different structures on 1042 inpatients with the tracer diagnosis of schizophrenia (ICD 10). We defined disease-specific indicators of structure, process, and outcome quality, developed an assessment instrument, and implemented a feedback system for quality comparison. The resulting quality profiles are useful as a starting point for internal quality management.
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ABSTRACT Der Beitrag erörtert, aufbauend auf früheren Überlegungen, die Begriffe Vorgestalt und Selbstkorrumpierung im Kontext der psychiatrischen Begutachtung affektiv akzentuierter Delikte. In beiden Fällen handelt es sich um komplexe... more
ABSTRACT Der Beitrag erörtert, aufbauend auf früheren Überlegungen, die Begriffe Vorgestalt und Selbstkorrumpierung im Kontext der psychiatrischen Begutachtung affektiv akzentuierter Delikte. In beiden Fällen handelt es sich um komplexe psychopathologische Phänomene, die auf den Beurteilungsebenen des Querschnitts (Befund zu einem bestimmten Zeitpunkt) und Längsschnitts (Entwicklung über die Zeit bis hin zur Tathandlung) erfasst werden müssen. Vorgestalten meint hier kognitiv mehr oder weniger strukturierte, imaginierte Vorwegnahmen wesentlicher Elemente eines später real eingetretenen, stark affektiv geprägten Tatzusammenhangs. Sie können im Einzelfall für oder gegen die Annahme einer erheblich eingeschränkten Steuerungsfähigkeit sprechen. Welche Indikatorfunktion sie haben, hängt vom psychopathologischen Kontext ab. Der nicht wertfreie Begriff Selbstkorrumpierung bezeichnet eine komplexe, nicht leicht erkennbare Alteration des individuellen Wertgefüges im (möglicherweise jahrelangen) Vorfeld der Tat. Auch dieses Phänomen kann für die forensische Beurteilung einer affektiv akzentuierten Straftat hilfreich sein, sofern es kritisch reflektiert verwendet wird. Der psychopathologischen Perspektive kommt in dieser Debatte eine kardinale Bedeutung zu. Dies gilt freilich nur dann, wenn die Psychopathologie sich in ihrem Selbstverständnis klar jenseits der bloßen Symptomerhebung bewegt und dabei die wissenschaftstheoretische und wissenschaftshistorische Perspektive aktiv einbezieht. This paper addresses imaginative preoccupations (“Vorgestalten”) and mechanism of self-corruption prior to a crime of passion (“Affektdelikt”). Both are complex psychopathological issues which have to be evaluated for cross-sectional and longitudinal dimensions. Imaginative preoccupations indicate cognitive and affective precursors of significant elements of the later aggressive criminal behaviour. Depending on the given psychopathological context, they may be indicative for or against diminished criminal responsibility. Self-corruption is definitely a (negatively) value-laden term and addresses a gradual alteration of the individual value system prior to the actual aggressive behaviour which can, but does not necessarily have to be of forensic relevance. Generally speaking, the psychopathological perspective is of major importance here, if and only if psychopathology clearly reaches beyond mere description of symptoms and systematically includes epistemology and conceptual history of psychiatry. SchlüsselwörterAffektdelikt-Vorgestalten-Selbstkorrumpierung-Schuldfähigkeit-Psychopathologie KeywordsCrime of passion-Imaginative preoccupations-Self-corruption-Criminal responsibility-Psychopathology
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ABSTRACT
Die Geschichte der Psychiatrie kann auch gelesen werden als eine Geschichte wechselnder theoretischer Rahmen, insbesondere mit Blick auf die Frage, was denn eigentlich eine seelische Erkrankung sei und wie ihr diagnostisch und... more
Die Geschichte der Psychiatrie kann auch gelesen werden als eine Geschichte wechselnder theoretischer Rahmen, insbesondere mit Blick auf die Frage, was denn eigentlich eine seelische Erkrankung sei und wie ihr diagnostisch und therapeutisch zu ...
Delusional syndromes can occur in a number of psychiatric, neurological or other disorders. They can also be caused by neurotoxic agents (e.g., heavy metals) as well as substance addiction. There are several hypotheses on the underlying... more
Delusional syndromes can occur in a number of psychiatric, neurological or other disorders. They can also be caused by neurotoxic agents (e.g., heavy metals) as well as substance addiction. There are several hypotheses on the underlying cognitive or emotional processes associated with organic factors of delusional disorders, depending on the patient groups examined and the methods used. The aim of this paper is to provide a comprehensive review and critical assessment of the various, rather heterogeneous theories in this field.
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... Emil Kraepelin postulated that psychotic disorders may be classified in a natural (ie, primarily biological) system, no matter which scientific method is ... It must also be taken into account thatZeki and Moutoussis (Moutoussis and... more
... Emil Kraepelin postulated that psychotic disorders may be classified in a natural (ie, primarily biological) system, no matter which scientific method is ... It must also be taken into account thatZeki and Moutoussis (Moutoussis and Zeki, 1997) found that changes in color are seen ...
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The number of patients who survive acute myocardial infarction has increased during recent decades. In addition, demographic development results in a rising incidence of cardiovascular diseases. Based on these facts, also the significance... more
The number of patients who survive acute myocardial infarction has increased during recent decades. In addition, demographic development results in a rising incidence of cardiovascular diseases. Based on these facts, also the significance of psychiatric disorders is growing that may occur after myocardial infarction, such as depression, posttraumatic stress and anxiety disorders. Physicians are faced with the challenge to identify these clinical entities, that show a syndromal overlap with somatic complaints after myocardial infarction. After differentiation prompt start of adequate psychiatric-psychotherapeutic interventions is of relevance, not only regarding the patient&amp;amp;amp;amp;#39;s quality of life, but also in terms of cardiovascular prognosis. Indeed, depressive and anxiety disorders are known to be associated with a poor compliance as for rehabilitation and secondary prevention of cardiovascular disorders. Moreover, some studies suggest depression to be an independent risk factor of coronary heart disease. Consequently, early recognition and treatment, most often primarily in the hands of internists and cardiologists, are of enormous importance for the course and prognosis of the psychiatric disorder but also of cardiovascular disease.
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In Anbetracht der aktuellen, angefochtenen Situation des Faches Psychiatrie wird dieses Kapitel einerseits den Blick auf eine psychiatriehistorisch wichtige Figur werfen, andererseits aber diese historische Perspektive auf die Gegenwart... more
In Anbetracht der aktuellen, angefochtenen Situation des Faches Psychiatrie wird dieses Kapitel einerseits den Blick auf eine psychiatriehistorisch wichtige Figur werfen, andererseits aber diese historische Perspektive auf die Gegenwart beziehen und so die Praxisrelevanz vermeintlich »nur« theoretischer Überlegungen aufzeigen. Im Vordergrund werden die Person und vor allem das Werk Emil Kraepelins stehen. Dabei wird in exemplarischer Weise auch seine drastisch
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In a 15-year follow-up study, we used a comparative approach to assess course and outcome for all functional psychoses. The presented results focus on negative symptoms and refer to a sample of 76 patients with schizophrenia, 38 patients... more
In a 15-year follow-up study, we used a comparative approach to assess course and outcome for all functional psychoses. The presented results focus on negative symptoms and refer to a sample of 76 patients with schizophrenia, 38 patients with a schizoaffective disorder and 32 patients with an affective disorder according to ICD-9. These patients were assessed at their first psychiatric hospitalization and 15 years later. In summary, the findings indicate that the course and outcome of schizophrenia is less favorable than that of affective and schizoaffective disorders. Negative symptoms occurred in all functional psychoses, but were more frequent and prominent in the schizophrenic group than in the other two diagnostic groups at any time of assessment. Narrower concepts of negative symptoms, conceptualized as the deficit syndrome, seem to be specific for schizophrenia and appear quite rarely in patients with affective psychoses. Overall, our study supports Kraepelin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s original hypothesis that bifurcated the psychoses into the affective psychoses and schizophrenia, whereby the latter have a more deleterious long-term course and outcome.
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ABSTRACT
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Delusional syndromes can occur in a number of psychiatric, neurological or other disorders. They can also be caused by neurotoxic agents (e.g., heavy metals) as well as substance addiction. There are several hypotheses on the underlying... more
Delusional syndromes can occur in a number of psychiatric, neurological or other disorders. They can also be caused by neurotoxic agents (e.g., heavy metals) as well as substance addiction. There are several hypotheses on the underlying cognitive or emotional processes associated with organic factors of delusional disorders, depending on the patient groups examined and the methods used. The aim of this paper is to provide a comprehensive review and critical assessment of the various, rather heterogeneous theories in this field.
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We report the case of a patient referred to our department with the diagnosis of conversion disorder, who ultimately proved to have neurosarcoidosis presenting with mild cognitive disorder. Despite the criticism of mild cognitive disorder... more
We report the case of a patient referred to our department with the diagnosis of conversion disorder, who ultimately proved to have neurosarcoidosis presenting with mild cognitive disorder. Despite the criticism of mild cognitive disorder as a diagnostic entity, our patient met the criteria for it. The reported case exemplifies the difficulties in classifying mild cognitive deficits in patients suffering from brain diseases without major morphological damage.
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Research Interests: Psychiatry, Schizophrenia, Treatment Outcome, Comorbidity, Probability, and 17 moreHumans, Major Depressive Disorder, Hospitalization, Female, Male, Statistical Significance, Follow-up studies, Depressive Disorder, Patient Admission, Rating Scale, Adult, Psychotropic Drugs, Psychotic Disorders, Depressive Symptoms, Treatment Response, Psychiatric Status Rating Scales, and Acute Disease
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This paper links the historical perspective with the actual debate on the concept of schizophrenia. By this, two aims shall be accomplished. First, to prove that Eugen Bleuler&amp;amp;amp;amp;#39;s (1857-1939) concept of... more
This paper links the historical perspective with the actual debate on the concept of schizophrenia. By this, two aims shall be accomplished. First, to prove that Eugen Bleuler&amp;amp;amp;amp;#39;s (1857-1939) concept of &amp;amp;amp;amp;#39;schizophrenia&amp;amp;amp;amp;#39; in its central parts was a clear step forward, as compared to previous approaches, especially the notion of &amp;amp;amp;amp;#39;dementia praecox&amp;amp;amp;amp;#39;, proposed and favored by French authors like Bénédict Augustin Morel (1809-1873) and, in Germany, by Emil Kraepelin (1856-1926). Bleuler considerably reduced the epistemological presuppositions of Kraepelin&amp;amp;amp;amp;#39;s nosological model and coined the term &amp;amp;amp;amp;#39;group of schizophrenias&amp;amp;amp;amp;#39;, which was markedly broader and, as for prognosis, much less pessimistic. The second aim of this paper is to argue in favor of a continuous reflection upon psychiatry&amp;amp;amp;amp;#39;s historical and epistemological basis which is regarded not just as &amp;amp;amp;amp;#39;l&amp;amp;amp;amp;#39;art pour l&amp;amp;amp;amp;#39;art&amp;amp;amp;amp;#39;, but as an indispensable component of psychiatry, clinically and scientifically.
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Human cortical somatosensory evoked potentials (SEPs), which are presumably generated in afferent thalamocortical and early cortical fibers, reveal a burst of superimposed early (N20) high-frequency oscillations (HFOs), around 600 Hz.... more
Human cortical somatosensory evoked potentials (SEPs), which are presumably generated in afferent thalamocortical and early cortical fibers, reveal a burst of superimposed early (N20) high-frequency oscillations (HFOs), around 600 Hz. There is increasing evidence of an imbalance of thalamocortical systems in schizophrenic patients. In order to assess correlations between somatosensory evoked oscillations and symptoms of schizophrenia, we investigated median nerve SEPs in 20 inpatients and their age-matched and gender-matched healthy controls using a multichannel EEG. Dipole source analysis and wavelet transformation were performed before and after application of a 450-Hz high-pass filter. In schizophrenics, the maximum HFOs occurred with a significantly prolonged latency. There was also a higher amplitude (energy) in the low-frequency range of the N20 component compared with the controls. Importantly, amplitudes (energy) of HFOs were inversely correlated with symptoms of formal thought disorder and delusions. Alterations of the thalamocortical somatosensory signal processing in schizophrenia with absence of an early HFO - assumed to be of inhibitory nature - could indicate a dysfunctional thalamic inhibition with increased amplitudes of N20, paralleled by enhanced positive schizophrenic symptoms.
Research Interests: Cognitive Science, Signal Processing, Schizophrenia, Psychopathology, Low Frequency, and 17 moreHigh Frequency, Brain Mapping, Humans, Wavelet Transform, Female, Male, Reaction Time, Oscillations, Clinical Sciences, Middle Aged, Adult, Static Source Code Analysis, Neurosciences, Median Nerve, Statistics as Topic, Psychiatric Status Rating Scales, and Neuropsychological Tests
The electrically elicited blink reflex consists of three components (R1, R2, R3). In humans the excitability of these components is influenced by attentional states. In particular, distraction from the stimulus leads to facilitation of... more
The electrically elicited blink reflex consists of three components (R1, R2, R3). In humans the excitability of these components is influenced by attentional states. In particular, distraction from the stimulus leads to facilitation of the bilateral R2 and R3. The present study was performed in order to investigate the excitability of the different components of the electrically evoked blink reflex in 13 patients with schizophrenia and 13 normal controls under standard conditions. Therefore, the thresholds of the distinct components were determined without any inhibitory or facilitatory procedure. There was no significant difference in R1 and R2 thresholds between patients and controls. In contrast, the R3 threshold was significantly reduced in schizophrenic patients (R3 threshold = 17.5 mA in normal subjects, 10.5 mA in patients, p = 0. 0001). In recent studies the R3 magnitude was found to be highly susceptible to changes in the attentional state of normal subjects. The lower threshold of R3 in patients with schizophrenia might therefore be a neurophysiological marker of attentional dysfunctions in schizophrenia.
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Psychopathology is usually recognized as an important clinical and research tool in psychiatric textbooks. However, in the era of operationalized psychiatric diagnosis, therapeutic guidelines and strong neuroscientific impact on the... more
Psychopathology is usually recognized as an important clinical and research tool in psychiatric textbooks. However, in the era of operationalized psychiatric diagnosis, therapeutic guidelines and strong neuroscientific impact on the self-understanding of psychiatry, its role became somewhat insecure in recent decades. And it has even been argued that psychopathology will sooner or later be fully replaced by neuroscientific concepts. This paper elucidates the theoretical (and, partly, historical) framework of this debate and argues for a modern understanding of psychopathology. This understanding will, on the one hand, be compatible with neurobiological and social sciences appoaches to mental illness, and, on the other hand, will not abandon psychopathology&amp;amp;amp;amp;#39;s demand to be an indispensable foundation of psychiatry.
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Kraepelin&#39;s main positions in forensic psychiatry, that are understandable only in the context of his underlying psychiatric and, especially, nosological theory, are the following: (1) Criminal behavior, especially if repeatedly... more
Kraepelin&#39;s main positions in forensic psychiatry, that are understandable only in the context of his underlying psychiatric and, especially, nosological theory, are the following: (1) Criminal behavior, especially if repeatedly shown by the same individual, should be regarded as (or, in the strongest version possible, is) mental illness; (2) above all, this viewpoint is due to Kraepelin&#39;s broad acceptance of degeneration theory in general, whereas he rejected simplifying concepts like Lombroso&#39;s early hypothesis of clinically observable &quot;stigmata degenerations&quot;; (3) Kraepelin voted for the acceptance of diminished responsibility to provide a more differentiated spectrum for the psychiatric expert and the judge; (4) because delinquency, in his view, was closely linked with mental illness, which should be treated instead of (only) being punished, he strictly objected to the death penalty; and (5) he suggested significantly increasing psychiatry&#39;s influence on decisions regarding the kind and length of imprisonment.
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Emil Kraepelin&amp;amp;amp;amp;#39;s contribution to the clinical and scientific field of psychiatry is recognized world-wide. In recent years, however, there have been a number of critical remarks on his acceptance of degeneration... more
Emil Kraepelin&amp;amp;amp;amp;#39;s contribution to the clinical and scientific field of psychiatry is recognized world-wide. In recent years, however, there have been a number of critical remarks on his acceptance of degeneration theory in particular and on his political opinion in general, which was said to have carried &amp;amp;amp;amp;quot;overtones of proto-fascism&amp;amp;amp;amp;quot; by Michael Shepherd [28]. The present paper discusses the theoretical cornerstones of Kraepelinian psychiatry with regard to their relevance for Kraepelin&amp;amp;amp;amp;#39;s attitude towards degeneration theory. This theory had gained wide influence not only in scientific, but also in philosophical and political circles in the last decades of the nineteenth century. There is no doubt that Kraepelin, on the one hand, accepted and implemented degeneration theory into the debate on etiology and pathogenesis of mental disorders. On the other hand, it is not appropriate to draw a simple and direct line from early versions of degeneration theory to the crimes of psychiatrists and politicians during the rule of national socialism. What we need, is a differentiated view, since this will be the only scientific one. Much research needs to be done here in the future, and such research will surely have a significant impact not only on the historical field, but also on the continuous debate about psychiatry, neuroscience and neurophilosophy.
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Abstract Theoretical papers on the nature of psychiatry and its position amongst the medical specialities are increasing in number and quality. Authors seem in need of two strategies: on the one hand to avoid simplifying and dichotomizing... more
Abstract Theoretical papers on the nature of psychiatry and its position amongst the medical specialities are increasing in number and quality. Authors seem in need of two strategies: on the one hand to avoid simplifying and dichotomizing psychiatric concepts into'good'and' ...
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Abstract The present-day scientific literature on fundamental issues in psychiatry and psychopathology centers around the following topics: scientific status of psychiatry, especially in comparison with other fields of medicine; basic... more
Abstract The present-day scientific literature on fundamental issues in psychiatry and psychopathology centers around the following topics: scientific status of psychiatry, especially in comparison with other fields of medicine; basic problems of psychiatric ...
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It is our objective to examine the phenomenon of mad scenes in bel canto opera from a modern perspective. The development of psychiatry and music at the beginning of the 19th century is described. Common elements of romantic music and... more
It is our objective to examine the phenomenon of mad scenes in bel canto opera from a modern perspective. The development of psychiatry and music at the beginning of the 19th century is described. Common elements of romantic music and mental disorders are discussed. It is shown how bel canto composers represent psychiatric illness by musical means. The psychopathology depicted in a prototypical mad scene is evaluated. Early romantic music is characterized by imagination, illusion and loss of structure; characteristics which can be well expressed in mad scenes. While madness (withdrawal into a utopian world) gained a certain attraction in society, clinical psychiatry increasingly focused on emotional causes of illness and on drug-induction of mental disorders. Mad scenes in bel canto opera can be understood as expression of an increasing interest in emotional aspects in music and society as well as in clinical psychiatry.
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The fundamentals of Kraepelin's theory have been revisited by researchers known as "neokraepelians", from the stand point of the neurobiology. In the case of the revision of Kraepelin, as it happens with other authors, there... more
The fundamentals of Kraepelin's theory have been revisited by researchers known as "neokraepelians", from the stand point of the neurobiology. In the case of the revision of Kraepelin, as it happens with other authors, there are some acritical reductionisms. This article tries to make a contribution to the understanding of Kraepelin's thought as well as the historical context of his work, starting with a revision of the clinical and practical position in the present psychiatry.
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Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with... more
Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;heavy user&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; profiles. These individuals often times change their residence and are extensively hospitalized on acute psychiatric wards. To date, little is known about the needs of providers of sheltered and supported housing concerning cooperation with psychiatric hospitals and support by psychiatric services. An explorative survey was conducted among the sheltered and supported housing facilities in the canton of Zurich. A short questionnaire was distributed among all 140 institutions in written form. The responses were analyzed thematically with respect to four predefined categories. Fifty-six institutions providing 1,600 places (about 50 % of the capacity in the canton of Zurich) responded. Experiences and problems with the focus group of residents as well as causes for problematic courses are described. A sound working routine with the psychiatric hospitals was considered as a precondition for the provision of high quality housing support. The needs concerned regular and flexible cooperation with psychiatric hospitals as well as open communication in particular at discharge from the clinic and intake at the housing facility. Concentration of competencies and knowledge within psychiatric hospitals about sheltered housing institutions and their needs could improve service provision and may result in higher certitude of housing facilities. Thereby, their ability to manage patients with severe mental illness could be improved and extensive hospitalization of individuals from this group could be reduced.
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To examine recent publications on implications of recovery for the provision of mental health services. Predominantly, the concept of recovery, implications for professional mental health services, and the impact of peer workers on the... more
To examine recent publications on implications of recovery for the provision of mental health services. Predominantly, the concept of recovery, implications for professional mental health services, and the impact of peer workers on the provision of healthcare are discussed. Recovery in the context of mental health issues refers to multiple dimensions of the individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s development. According to recent publications, the dimension of an individual journey, measurable through subjective parameters and accounts, is complementary to the traditional objectives of symptom reduction, improvement of functioning, and social inclusion. To foster recovery orientation in mental health services subjective measures should be included in clinical practice, research, and teaching. Moreover, services striving to support recovery need to implement strategies in terms of policy, concepts, structures, and professional attitude. This challenging paradigm shift is claimed to be supported by the integration of peer workers with own lived experience in the provision of mental healthcare. Some exponents of the social recovery movement criticize this recent international development to implement recovery into traditional services, as it would uphold the established structures of power and control. Questions of impaired legal capacity, involuntary admissions and risk assessment related to recovery are rarely discussed.
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The first such patron was Joo Cidade (1495-1550) who, after experiencing at first hand the brutal treatments to which the insane were subjected, began to preach in their favour, resulting in the creation of the Order of St John of God.... more
The first such patron was Joo Cidade (1495-1550) who, after experiencing at first hand the brutal treatments to which the insane were subjected, began to preach in their favour, resulting in the creation of the Order of St John of God. This event corresponds to the development of ...
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Delusion has always been a central topic for psychiatric research with regard to etiology and pathogenesis and to diagnosis, treatment, and forensic relevance. Throughout the history of psychiatry as a scientific discipline, there has... more
Delusion has always been a central topic for psychiatric research with regard to etiology and pathogenesis and to diagnosis, treatment, and forensic relevance. Throughout the history of psychiatry as a scientific discipline, there has been dissent on the issue of whether chronic delusion is a nosological entity of its own or just a specific type of another mental disorder, e.g. schizophrenia, mania, or personality disorder, and there already is a considerable literature on this. This article seeks to elucidate the central lines of thought that have governed the scientific debate on delusions and delusion-associated phenomena since the early 19th century. Special attention is given to the practical relevance of these theoretical considerations for forensic questions and psychiatric research. Due to the complex features of delusions, research in this area may well become paradigmatic for many other complicated psycho(patho)logical phenomena, e.g. consciousness, hallucinations and psychotic depression.
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The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in... more
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essentialism, and stigma.