[Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures]. / Suizid im psychiatrischen Krankenhaus : Ergebnisse, Risikofaktoren, therapeutische Maßnahmen.

Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.

[Suicidal behavior: a psychiatric emergency situation, suicide prevention: a psychiatric obligation]. / Suizidalität: ein psychiatrischer Notfall, Suizidprävention: eine psychiatrische Verpflichtung.

In German psychiatry suicidal behavior is seen as sign of a psychiatric crisis in a person in the context of psychopathology, psychodynamics and psychosocial situation. Psychiatric disorders are found in up to 90% of people who commit suicide and the time span following the decision to commit suicide is often very short, within 24 h. Suicide prevention is a central duty and obligation in psychiatry and psychotherapy. This article gives an overview on the current state of knowledge on suicide from a clinical point of view.

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression.

BACKGROUND: A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide. AIMS: To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state. METHOD: Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety. RESULTS: The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode. CONCLUSIONS: The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.

[Suicidality]. / Suizidalität.

Suicidality has always been a part of human history. No thinking or behavior has however gone through such a range of judgments in the course of time. As a "medical-psychosocial paradigm" suicidality now involves a wide range of medical, psychosocial, theologic, and philosophic fields. For dealing psychiatrically with suicidal patients as part of a psychosocial, psychotherapeutic treatment method, a summary is presented of forms, epidemiology, models of development and etiopathogenesis, and the prevention and therapy of suicidal behavior.

[Depression and suicide]. / Depression und Suizid.

Depression is the most common psychiatric disorder in the general community. Depression is accompanied with the highest suicide risk. 3 % to 4 % of all depressives die by suicide even today. Suicide prevention is an important part of diagnostics, therapy, the long-term treatment, and care of depressed patients. Psychotherapeutic and psychopharmacological aspects must be included.

[Suicide and suicide prevention for female and male physicians]. / Depressionen und Medikamentenmissbrauch gehen meist voraus. Arztinnen haben ein besonders hohes Suizidrisiko.

The medical profession represents one of the groups of people who are not reached by the present help system for suicidal behaviour. The suicide rate of male physicians is slightly higher than that of the general population, while that of their female colleagues is clearly higher. This tendency is most pronounced in female psychiatrists and anaesthetists. In addition to the usual preventive measures such as the treatment of depression and addiction, the necessity of a qualified, professional treatment especially for doctors must be recognized because there is often a penchant for ineffective self-treatment. The symptoms are played down and even in acute crisis situations the urgently needed help is not enlisted.

[Stability of the "amok runner syndrome"]. / Zur Stabilität des "Amokläufer"-Syndroms.

BACKGROUND: Running amok is considered a rare but dangerous act of violence which has been investigated predominantly on a case by case basis. German-wide data on amok cases covering the decades 1980 - 1989 and 1991 - 2000 were used to perform the first epidemiological study world-wide on the stability of socio-demographic, criminological and psychiatric variables of amok behaviour. METHODS: A content analysis study on nation-wide press reports of amok cases included a total of 104 subjects who were identified by combined homicidal-suicidal acts of violence and fulfilled structured criteria originally defined according to former Malayan amok events. RESULTS: Amok cases in both decades were comparable except for the significant increase of weapon use, especially of firearms. Total prevalence showed a tendency to decline from 1 : 5.5 million to 1 : 8.5 million men per year, females were involved in rare single cases only. The male offenders showed a bimodal age distribution with a mean of 35 years. They were professionally well qualified, but had a 5 - 7fold higher risk of unemployment than the normal population. Motives and reasons for running amok were serious but not unusual, they varied widely and addressed all areas of daily life. Most offenders were characterized by abnormal personality patterns such as passive, aggressive, impulsive and paranoid and were in possession of firearms and previously convicted. Psychiatric diseases such as psychosis, paranoia, depression or personality disorders were present in more than 50 % of cases; further 20 % were intoxicated. The presence of psychiatric disorders influenced patterns of violent behaviour in individual subjects. Victims were predominantly unknown to the offenders. Close to one third of the amok runners committed suicide or were killed by legal authorities. CONCLUSION: Amok represents a temporarily stable syndrome of extreme violent behaviour even in modern industrialized societies. Subjects exhibit a complex combination of serious causative motives, social burden and psychiatric diseases which do not explain common causes of amok rather than the origin of amok behaviour in individual cases. Amok joins the wide spectrum of human homicidal-suicidal acts which show similarities in many aspects.

[Differential indications for atypical neuroleptics: Amisulprid, Clozapin, Olanzapin, Quetiapin und Risperidon. Results of a pilot study of prescription habits in psychiatric clinical usage in the BRD]. / Differenzialindikation atypischer Neuroleptika: Amisulprid, Clozapin, Olanzapin, Quetiapin und Risperidon. Ergebnisse einer Pilotstudie zu Verordnungsgewohnheiten in psychiatrischen Versorgungskliniken der BRD.

With the introduction of atypical neuroleptics, the therapy of schizophrenia has been improved by a group of antipsychotic substances characterized by better tolerability concerning extrapyramidal side effects and higher efficiency against negative symptoms. However, these atypical antipsychotics are not a homogeneous class of drugs but rather represent a group of substances with very different neurobiologic, pharmacologic, and clinical features. This fact and the growing variety of available atypical neuroleptics illustrate the difficulty in choosing the "right" antipsychotic drug for each patient. The aim of this investigation was to evaluate preliminary empirical data for possible differential indication of atypical neuroleptics by a questionnaire-based survey of 192 physicians in ten psychiatric hospitals active in the biological psychiatry work group of the German Federal Directors' Conference.

[Psychiatric-psychotherapeutic inpatient treatment for depression. Process and outcome quality based on a model project in Baden-Wurttemberg]. / Stationäre psychiatrisch-psychotherapeutische Depressionsbehandlung Prozess- und Ergebnisqualität anhand eines Modellprojekts in Baden-Württemberg.

During 1998-2000 a quality assurance program for diagnosis and treatment of depression was conducted in 24 hospitals for psychiatry and psychotherapy in Baden-Wurttemberg (southern Germany). Process and outcome quality of 3,000 depressive patients was documented at admission and discharge. The article focuses on therapeutic measures, duration, outcome, patient satisfaction, and their interactions. The results show that the patients' satisfaction with the care received is very high and the pre-post effect sizes of inpatient treatment for depression are high.

[Suicide prevention by the general practitioner]. / Suizidgefährdeter Patient. Krisenbewältigung in der Hausarztpraxis.

Although suicides in Germany are on the decrease, for the care-providing physician a suicidal patient must always be considered an emergency. An elevated risk is to be seen above all in patients with psychological/mental problems, in particular those suffering from depression, but also those experiencing a crisis associated with ageing, physical illnesses or intolerable social situations. A range of factors may influence suicidal behavior, such as the specific situation of the patient or the loss of protective factors. When his/her coping strategies or outside help then fails, a triggering event may prompt suicide. As a rule, the suicide-endangered patient goes through three stages--a period of weighing up, ambivalence and decision-taking. For the care-providing physician it is of particular importance to recognize the ambivalence stage in good time, for it is here that the patient gives expression to thoughts of suicide and the physician has an opportunity to intervene. Major preventive measures are the build-up of a doctor-patient relationship and a readiness to "talk things through". Further crisis management includes, for example, the use of psychopharmaceuticals or the initiation of psychotherapy.

Hospital admission circumstances and prevalence of frontotemporal lobar degeneration: a multicenter psychiatric state hospital study in Germany.

Frontotemporal lobar degeneration (FTLD) is a heterogenous, non-Alzheimer's disease, dementia complex with variable clinical presentation. We carried out a prospective nationwide hospital-based clinico-epidemiologic study in geriatric psychiatry to estimate the prevalence and admission circumstances of patients with FTLD. During a 4-week period 33 patients with clinical FTLD were prospectively ascertained in 36 psychiatric state hospitals in Germany with a total catchment area of >20,000,000 people. The relative portion of FTLD patients within the primary dementia population accounted for 1.9%. The estimated prevalence of FTLD in Germany was 47.9/100,000 population aged between 45 and 79 years. The admission circumstances were mainly behavioral disturbances (54.5%), unclear syndromes of dementia (18.1%) and further remarkably heterogeneous psychiatric syndromes. FTLD is a common cause of dementia in geriatric psychiatry with a variable clinical presentation that could mimic most of the major psychiatric diseases. Patients with FTLD may be older than previously assumed (mean age at admission 63.9 years) and show their maximum age-related prevalence between 60 and 70 years (78.7/100,000).

[How and to what extent is suicide postvention part of the routine of health care professionals in psychiatric hospitals after inpatient suicide?]. / Umgang mit dem Patientensuizid in therapeutischen Teams psychiatrischer Kliniken - Ergebnisse einer Umfrage -

OBJECTIVE: To elucidate how and to what extent suicide postvention is part of the routine of health care professionals in psychiatric hospitals after inpatient suicide was aim of the study. METHODS: In 11 South German psychiatric hospitals the head of the nursing team of the ward, the therapist and the medical assistant director were asked how suicide postvention after the last suicide was handled. RESULTS: Suicide postvention is part of the routine in these hospitals and discussion on the issue is rather open. The members of the team confronted with suicide feel mostly sufficiently supported. (2/3) of both therapists and heads of nursing teams considered the procedere to be adequate. CONCLUSION: Mainly for the nursing team there seems to be a need to further improve procedures for suicide postvention to gain more team satisfaction with regard to how the situation is managed.

[The development of suicide rates in the Bezirkskrankenhaus Bayreuth 1976 - (including) 2000]. / Die Entwicklung der Suizidzahlen und -raten im Bezirkskrankenhaus Bayreuth 1976 - einschliesslich 2000.

Newer publications about psychiatric in-patient suicide discuss the so-called "increase hypothesis" of suicide of mentally ill in-patients controversially. In our study of in-patient suicides of the Bezirkskrankenhaus Bayreuth, a state mental hospital for adult psychiatry, the number of suicides and suicide rate over 25 years 1979 - 2000 did not show any increase. During the last 4 - 5 years we observe a trend toward a decrease.

[The aftermath of suicide of a psychiatric inpatient - experiences in psychiatric hospitals with relatives as suicide survivors]. / Nach dem Suizid eines Patienten - Erfahrungen mit Angehörigen von Suizidenten in der psychiatrischen Klinik.

OBJECTIVE: In a first part we describe the situation of suicide survivors after the suicide of a family member in USA and Germany by reviewing the literature. In a second part we try to elucidate typical patterns of reactions and coping of relatives. METHODS: On the basis of either own experience or from supervision cases, we try to elaborate reaction types of relatives of inpatients who committed suicide. RESULTS: Relatives as suicide survivors show reactions from shock, disbelief, grief, guilt, self-doubt, anger and relief to accusation and threat of lawsuit toward therapists. An attempt is made to subsummarize these reactions in three preliminary categories. CONCLUSIONS: Generally, relatives should be offered the opportunity of more than one common talk with the health care professionals. Postvention is preventive work, that aims at avoiding that the suicide survivors becomes a patient himself.