[Advance directives and mental disorders: a practice recommendation of the Commission for Ethics and Law of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. / Patientenverfügungen und psychische Erkrankung ­ eine Praxisempfehlung der Kommission Ethik und Recht der DGPPN.

BACKGROUND: Since the creation of legal requirements for advance directives by the legislator in 2009, special aspects of their application in the treatment of people with mental illnesses have been discussed. GOAL OF THE PAPER: Important questions on dealing with advance directives in everyday life will be answered in a practice-oriented manner. RESULTS: Among other things, this document answers the question of the conditions under which a patient can refuse or consent to hospitalization and treatment in advance, and in particular how to deal with advance directives whose implementation would also affect the rights of third parties. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has addressed these and other questions in the present document and added practical advice on how to formulate advance directives for people with mental illnesses and how to deal with psychiatric advance directives. DISCUSSION: The DGPPN has developed an advance directive for the area of mental health and published it on its website together with detailed explanations. With the help of this advance directive, people can decide on their treatment in phases of incapacity to consent in the context of a mental crisis or illness.

[Revision of §64 of the German Penal Code from a psychiatric perspective-Position paper of a task force of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. / Neuregelung des § 64 StGB aus psychiatrischer Sicht ­ Positionspapier einer Task-Force der DGPPN.

In Germany every second offence occasioning bodily harm and every fourth sexual offence occur under the influence of alcohol or drugs. Untreated substance use disorders are a risk factor for further offences. The §64 of the German Penal Code (StGB) regulates the commitment of offenders to a Forensic addiction treatment unit as a result of an addiction to excessive consummation of intoxicating substances. The previous regulation has come under criticism because too many patients are committed, the sentence is often given to the wrong persons, the treatment is often terminated without success and the sentence consumes to many resources. From a psychiatric perspective the reform of commitment to a Forensic addiction treatment unit (§64 StGB) must fulfil the principles of medical ethics, in particular the respect for the autonomy of the patient, the principle of distributional justice and the code of medical professional ethics. The commitment according to §64 must be restricted to the treatment of people with a clinically relevant substance use disorder. From a psychiatric perspective, decisive for the prospect of success are the willingness to be treated and self-determination for admission to the clinic. In order to release the treatment from the extrinsic influences of the enforcement law, on admission to treatment a sufficient amount of the sentence should have already been served that the commitment only serves the purpose of the treatment and resocialization, so that the risk of further substance-related offences is reduced. The legal term "Entziehungsanstalt" should be replaced by "Forensic Clinic for Dependancy Diseases".

[Failure of a study in forensic psychiatric hospitals : Clinical trial to investigate the additive effect of triptorelin on the efficacy of psychotherapy]. / Vom Scheitern einer Studie in Maßregelvollzugskrankenhäusern : Klinische Prüfung zum additiven Effekt von Triptorelin auf die Wirksamkeit von Psychotherapie.

BACKGROUND: A testosterone-lowering medication is relatively commonly used as a form of treatment for sexual offenders with severe paraphilic disorders in German forensic psychiatric hospitals; however, a double-blind, controlled and randomized study, which investigates the efficacy of this medication, is still lacking. AIM: This article describes the process from the planning to the rejection of a clinical trial over the period from 2009 to 2015. METHODS AND RESULTS: Despite the careful planning with an interdisciplinary team and giving special consideration to the complex legal situation, the Federal Institute for Drugs and Medical Devices (BfArM) rejected the proposed trial in a brief formal letter with reference to the German Drug Law (§ 40 para. 1 p. 3 nr. 4 AMG). The ethics committee of the Hamburg Medical Association considered that clinical research is basically not possible with patients detained in a forensic psychiatric hospital. DISCUSSION: In the opinion of the authors, the described facts illustrate how legal regulations that should protect vulnerable groups in medical research, in a specific case can lead to the fact that a therapy form relevant to the corresponding patient group cannot be scientifically investigated.

[Psychiatric treatment--legal aspects]. / Rechtliche Aspekte einer Behandlung in der Psychiatrie.

Doctors want to save lives and promote health. But their patients have the right to decide for themselves about what doctors do with them, and they are free to refuse treatment, even if it is unreasonable from a medical perspective. The law acknowledges this freedom even if a patient is incapable of responsible self-determination as a result of (mental) illness. Treatment contrary to the patient's declared intention will be allowed only under specific, narrow circumstances. These requirements must be legally established in a clear and precise manner.

Quality of life and body image after circumferential body lifting of the lower trunk: a prospective clinical trial.

BACKGROUND: Plastic surgery after massive weight loss remains a fast growing subspecialty. However, very few studies exist that investigate the quality of life and psychological outcome after body lift surgery. METHODS: Twenty-seven patients (25 females and 2 males) who had undergone bariatric surgery were scheduled for circumferential body lifting of the lower trunk. The patients, aged 21-58 years (mean = 39.9, SD = 10.9), underwent surgery in our department of plastic and reconstructive surgery between 2008 and 2010. All participants took part in two psychological examinations on a voluntary basis and completed the prospective pre-post study. RESULTS: Post-weight loss surgery improves the quality of life and body image. CONCLUSIONS: It is therefore an important part in the interdisciplinary treatment of the massive weight loss patient.

Scarpa fascia or rectus fascia in abdominoplasty flap elevation: a prospective clinical trial.

BACKGROUND: Postoperative seroma formation remains the most frequent complication after full abdominoplasty. This study aimed to evaluate postoperatively the formation of a minor seroma when the superficial fascia is used for preparation. METHODS: The study enrolled 50 patients who underwent a full abdominoplasty with umbilicus transposition between February 2008 and February 2010. The patients were alternated to the scarpa group or the rectus group. RESULTS: The two groups differed in terms of postoperative seroma formation and amount of average drain output. CONCLUSION: Scarpa fascia preservation seems to reduce postoperative seroma formation. The mechanism of the decreased fluid collection is not clear and needs further investigation.

Circumferential superficial fascia lift of the lower trunk: surgical technique and retrospective review of 50 cases.

BACKGROUND: The superficial fascia of the lower trunk has been described in its functional importance as a lifting layer by Lockwood in the early 1990s. Preparation more superficially is supposed to reduce the rate of seroma formation in abdominoplasty procedures. Using the superficial fascia in circumferential bodycontouring procedures of the lower trunk is assumed to combine these benefits. METHODS: Between November 2008 and April 2010, 50 patients were scheduled for circumferential superficial fascia lifting of the lower trunk at our department. Nine men and 41 women underwent a central or lower bodylifting procedure. The ultrasonically activated scalpel was used for preparation. RESULTS: Only one major complication (secondary bleeding) needing revision occurred. There were few minor complications such as seroma formation (8%) and superficial wound dehiscences <2 cm in extension (16%). No other complications occurred. CONCLUSION: The superficial fascia is an ideal layer for preparation and tissue lifting in circumferential bodycontouring of the lower trunk.

Postoperative splinting after open carpal tunnel release does not improve functional and neurological outcome.

Although surgical division of the transverse carpal ligament is the operative treatment of choice for carpal tunnel syndrome (CTS), controversy exists about the immediate postoperative treatment regimen. Splinting for up to 6 weeks after surgery is recommended by some investigators. We therefore evaluated effectiveness of splinting after open carpal tunnel surgery by a randomized, controlled trial. Fifty consecutive patients with clinically and electrophysiologically confirmed idiopathic CTS were assigned to open carpal tunnel release and randomized to receiving a light bandage (25 patients) or a bulky dressing with a volar splint (25 patients) for 2 days each. All patients were followed up at 3 months. Parameters retrieved were pain as measured using a visual analog scale, two-point discrimination, and grip strength, and nerve conduction studies. At follow-up, all patients reported definite improvement of symptoms, but there was no statistically significant difference between the two groups for any of our outcome measures. Thus, postoperative splinting after open carpal tunnel release does not yield any benefit to eventual outcome. In fact, it adds to the overall operating time and can safely be abandoned.