Driving skills in unmedicated first- and recurrent-episode schizophrenic patients.

The present study was designed to examine driving skills according to regulations of the German guidelines for road and traffic safety in unmedicated schizophrenic inpatients. A total of 13 first-episode (FES) and 13 recurrent-episode (RES) schizophrenic inpatients were included in the analysis and compared with a group of 20 healthy controls (HC). Data were collected with the computerised Wiener Testsystem measuring visual perception, reactivity and stress tolerance, concentration and vigilance. Analysis of data indicates that a great proportion (58 %) of schizophrenic patients were impaired in psychomotor functions related to driving skills. FES and RES significantly differed with respect to driving ability with a greater proportion in the FES (38 %) showing severe impairments when compared with RES (25 %). Differences with respect to HC performance were most pronounced in concentration and for the FES additionally in visual perception. Analysis of our data indicates that a great proportion of schizophrenic patients are impaired in psychomotor functions related to driving skills that cannot be attributed to adverse side effects of psychopharmacological treatment. Besides, we cannot confirm a chronical decline of psychomotor functions related to driving skills at least in the early course of schizophrenic illness.

[Infanticide. Social and forensic aspects]. / Kindstötungen. Soziale und gutachterliche Aspekte.

Infanticides are not specifically classified in German criminal records. Thus, the number of infanticides varies depending on different sources of information. Reports from expert witnesses (n=48, 1980-2007) from the German regions around Munich and Rostock were analyzed retrospectively in order to identify sociodemographic, clinical and forensic characteristics of child murders. In 87.5% of the cases the victims were the natural children of which 25 were younger than 1 year old. Female offenders outnumbered male offenders by 3:1 and on average females were 8 years younger than males (26.5 years for females and 34.2 years for males). The motives included unwanted pregnancy/child, altruistic deeds, acute psychoses, child abuse (sexual abuse, neglect or negligence), drug or alcohol abuse, sadistic punishment of the child and revenge on partners. In 27 cases a restricted or exemption from criminal responsibility was acknowledged. About one third of the offenders consulted a physician before the crime. For an improvement in primary prevention, support networks should be integrated and sensitized to the problem.

[Psychiatric assessment in civil law questions]. / Psychiatrische Begutachtung bei zivilrechtlichen Fragestellungen.

Psychiatric reports in German civil law cases are required if questions are raised of legal capacity, capacity to express a testamentary will, ability to sue or be sued, capacity to marry, ability of mentally disordered patients to consent to treatment, and when custody or hospital orders of these patients is considered or compensation is due for mental disorders resulting from accidents. Many reports must decide whether the ability to decide using sound reason or motives is or was impaired by a mental disorder. This capability is attributed to every adult person; only if incapability is claimed must it be proven by psychiatric assessment. As in most psychiatric court reports, such assessments must be structured in several steps. First a clinical diagnosis has to be established which must then be translated into legal terminology. After this has been accomplished, the psychiatrist must describe the functional impairments caused by the disorder and define the probability with which these impairments might affect the legal act in question. Most reports are prepared in the context of custody law, which centers on helping those patients who, due to a mental disorder, cannot manage their own legal matters.

[Structured psychiatric assessment of risk for violent recidivism in juvenile offenders]. / Psychiatrische Beurteilung des Gewaltrisikos im Jugendalter.

The psychiatric assessment of violence in youth represents a critical and essential part of forensic expertise and clinical practice. New methodical approaches are offered by structured risk rating scales and checklists which encompass psychopathy. The recently translated German version of Structured Assessment of Violence Risk in Youth (SAVRY), which is based on the Historical, Clinical, Risk Management Scheme (HCR 20), was evaluated in a sample of forensically assessed youth (n=83) regarding the predictive validity for criminal recidivism. Receiver operating characteristic (ROC) analyses attested medium (general delinquency), moderate (violent reoffending) and high (serious violent reoffending) effect strength, depending of the type of offence. Survival analyses showed that juveniles rated as high risk for violence were significantly faster and in a higher proportion recidivistic than those with a moderate or low risk. The results indicate the applicability of risk assessment instruments for German juveniles. Approaches for preventive, therapeutic and reintegrating measures are demonstrated, taking relapse patterns and dynamic risk aspects into consideration.

Short-term naloxone administration in schizophrenic and manic patients. A World Health Organization Collaborative Study.

A double-blind study of the behavioral effects of short-term naloxone hydrochloride administration was performed in 32 schizophrenic and 26 manic patients in a World Health Organization collaborative project. There was a significant naloxone-associated reduction in overall physician-rated symptoms in schizophrenic patients concurrently treated with neuroleptic medication (N = 19) but not in medication-free schizophrenics (N = 13). Physician rating of auditory hallucinations showed significant naloxone-associated improvement for the total schizophrenic population, while self-ratings of auditory hallucinations showed improvement only in neuroleptic-treated schizophrenics. While further studies are needed to delineate these effects as to clinical significance, they may bear etiological implications for the psychobiology of schizophrenia, including the possibility of synergistic effects of dopamine and endorphin blockade. Naloxone produced no significant behavioral effects in manic patients. These findings are discussed with relationship to the hypotheses of endorphin involvement in schizophrenia and mania.

Methysergide decreases prolactin release after FK 33-824 [Tyr-D-Ala-Gly-MePhe-Met(o)-ol], a potent analogue of methionine enkephalin. A study in man.

This study investigated the mechanisms which may underly the prolactin (PRL) stimulating effects of FK 33-824, a potent enkephalin analogue. FK 33-824 (1 mg) was infused in healthy volunteers before and after pretreatment with 3 mg methysergide, a serotonin receptor blocker. All subjects showed a release of PRL after FK 33-824, which was significantly diminished after pretreatment with methysergide.

Blood purification treatment of schizophrenia.

In order to gather information about the usefulness of blood purification methods as a treatment for chronic schizophrenic patients, "mini-questionnaires" were sent to all European centers working with this method. The questionnaires consisted of two parts, one asking the psychiatrist about the disease itself and the evaluation of treatment, the other one asking the nephrologist about the specific method used. --A preliminary report, based on the evaluation of 53 questionnaires indicated--although far from offering conclusive results--that all schizophrenic patients did not profit equally from the therapy and that patients treated for less than 6 hours per week were not likely to improve. Implications for further research are discussed.

[Criteral for assessing quantitative disability in expert determination of functional physical disorders. Review of the literature]. / Kriterien zur Beurteilung der quantitativen Leistungseinschränkung bei der Begutachtung funktioneller körperlicher Störungen. Eine Literaturübersicht.

The assessment of individuals with somatoform disorders seeking payments or compensation is a major challenge for psychiatrists, insurers and the social welfare system. It is difficult to examine these disorders objectively and to quantify the impairment people experience in their work or private life. In order to develop more rational criteria for the assessment of these patients, we first reviewed the relevant literature and extracted the criteria mentioned by the respective authors. We then grouped these criteria in clinically plausible dimensions in order to develop a list of parameters that could help psychiatric experts to analyse the impairment more objectively and to help institutions in evaluating the assessments.