[Health and Prevention Behaviour of Persons with and without Migration Background]. / Gesundheits- und Präventionsverhalten von Personen mit und ohne Migrationshintergrund.

Based on a sample of the Hannover registration office this project analyses the health and prevention behaviour of Russian- and Turkish-language migrants compared to natives. The project analysis revealed considerable differences, particularly concerning addiction behaviour and physical activities.

[Gender-specific differences relating to depressiveness in 1st and 2nd generation migrants: results of a cross-sectional study amongst employees of a university hospital]. / Geschlechtsspezifische Unterschiede bezüglich Depressivität bei Migranten der ersten und zweiten Generation: Ergebnisse einer Querschnittsuntersuchung an Beschäftigten einer Universitätsklinik.

AIMS: This study analysed the risk of depression in men and women with a background of immigration by means of a cross-sectional study amongst employees of a German university hospital. In addition we identified gender-specific differences related to risk factors for depressiveness in the subgroups. METHODS: 7062 employees with or without a 1st (1G) or 2nd (2G) generation background of migration were questioned with regard to their socio-economic status, to single markers of acculturation, and to existing symptoms of depression assessed on the general depression scale (CES-D). Odds ratios (OR) were calculated using logistic regression. RESULTS: The response rate was 41.7% (n=2932). In comparison to non-migrants a higher risk of clinically relevant depressiveness was found for 1G male migrants (OR 2.35, 95% Cl 1.11-4.96), 1G female migrants (OR 1.94, 95% Cl 1.26-2.97) and for 2G female migrants (OR 1.82, 95% Cl 1.03-3.19). There was no significant increase in risk for 2G male migrants (OR 1.06, 95% Cl 0.31-3.62). 2G female migrants who considered themselves to retain a "close relationship to their native culture" had a significantly higher risk of depression than 2G male immigrants (OR 7.31; p = 0.032). Male 1G migrants without a "close relationship to their native culture" had a significantly higher risk of depression than those with a "close relationship to their native culture" (OR 5.79; p = 0.010). CONCLUSIONS: The results of this study point to gender-specific risk constellations for depression amongst 1st and 2nd generation migrants. It would appear that a strong orientation to the native culture increases the risk of depression for 2G female migrants, whereas for 1G male migrants this factor is associated with a lower risk of depression.

Naturalistic pharmacotherapy of acute episodes of schizophrenic disorders in comparison to treatment guidelines.

INTRODUCTION: This study was designed to investigate to what extent guidelines regarding the pharmacological treatment of patients suffering from schizophrenia-like psychosis are adopted in a naturalistic treatment setting. METHODS: Medical records of n=819 patients undergoing inpatient treatment for schizophrenia-like psychosis in 11 psychiatric hospitals in northwestern Germany were retrospectively analyzed and findings were compared to current schizophrenia guideline recommendations. RESULTS: The prescription rate of second generation antipsychotics increased from 47.1% on admission to 62.5% at discharge. Only half the patients (52.3%) received antipsychotic monotherapy while 47.7% took between 2 and 4 antipsychotic substances at a time. Dosage increases occurred most frequently (in 60%) within the first week of inpatient treatment, 16.6% experienced an elevation between days 15 and 29. A change within the atypical medication was found in 19.3%. Clozapine prescriptions increased throughout the treatment but were combined with other antipsychotic substances in the majority of cases. CONCLUSION: Under naturalistic conditions guideline recommendations for treatment of schizophrenia-like psychosis are adhered to only partially. Combination therapy with 2 or more antipsychotic drugs is quite common despite a clear recommendation for monotherapy.

[Socialpsychiatric and ethical reflections about prevention of schizophrenic disorders]. / Sozialpsychiatrische und ethische Uberlegungen zur Prävention schizophrener Störungen.

PROBLEM: In the last years there has been a shift from curative to preventive objectives in politics (prevention law) and medicine, by which socialpsychiatric practice also is affected. This requires a critical reflection about ethical, methodical and therapeutic problems of the prevention of psychological disorders--especially schizophrenic psychosis. ARGUMENTS: Studies dealing with the prodromal stage of schizophrenia point to a successful early detection and intervention. But also negative consequences like stigmatization and side effects by psychotherapeutic or pharmacologic interventions should be taken into account. CONCLUSION: Under critical consideration of the ethical principles of not causing harm, acting for the well-being and the person's right of self-determination prevention should play a larger role in psychiatry. Therefore further empirical studies about the efficacy of early detection and intervention are needed.

[Psychiatric evaluation of immigrants ]. / Schwieriges Terrain für die medizinische Begutachtung.

The psychiatric evaluation of immigrants presents a particular challenge in the medical assessment process. Knowledge of cultural aspects of the aetiology, epidemiology and manifestation as well as the treatment of mental disorders is not only an important facet in daily psychiatric work with immigrants, it is also important for the assessment process itself.

[Transcultural aspects of suicidal behaviour]. / Suizidalität im Kulturvergleich.

Due to increasing immigration in Germany the German Mental Health Care System today has to deal in a growing number with the assessment of the level of psychic functioning and the capability of self control in patients of different ethnic origin. For clinicians this is a challenge, since suicidal behaviour in terms of its frequency, meaning, motives and manner is very much dependent on the cultural context in which it occurs. Moreover, the general attitude of an individual towards suicide is embedded in the culture of origin of the immigrant. Until now there has been only little systematic research on the influence of culture on suicidal behaviour. In this review the traditions of suicidal behaviour in different cultures in their religious and historical dimensions will be reflected. The historical and cultural roots of suicidal behaviour will be put in context to a categorization of the different variants of suicide, such as institutionalized suicide versus individualized suicide. Psychodynamic aspects of suicidal ideation will be highlighted in cross-cultural perspective with a distinction between a. the wish to die, b. the wish to kill and c. the wish to be killed. It will be shown that there can be differentiated between accepted and non-accepted suicide. With respect to epidemiology there will be discussed the impact of culture on the suicide rates across cultures. The influence of culture on the psychopathology of suicidal behaviour will be summed up systematically. These aspects are of high relevance for the understanding and assessment of suicidal crisis in immigrants, since the suicidal patient even today - although subconsciously - is influenced by the deep rooted traditions of suicidal behaviour in his culture of origin.

[Health and health care of migrants with particular regard to addiction]. / Gesundheit und gesundheitliche Versorgung von Migranten unter besonderer Berücksichtigung von Sucht.

Adequate knowledge about the target group is essential for user-focused health care. Little differentiated information on the health and health care of migrants is available in Germany, and focused research on migrant groups hardly exists. The burden of the migration itself, the change in the socioeconomic status (compared to the home country) and - compared with the locals - a more restricted access to the health care system affect the health of migrants. A major health problem with this group is addiction. Characteristics of health and health behaviour of Turkish- and Russian-speaking migrants in Germany are examined by a study supported by the German Federal Ministry of Education and Research.

[Quality management in sociopsychiatric service: the use of routine data in efficiency control and care planning]. / Qualitätsmanagement im Sozialpsychiatrischen Dienst: der Einsatz von Routinedaten für Leistungscontrolling und Versorgungsplanung.

Caring for psychiatric patients, Social Psychiatric Services (SpDi) carry out advising and therapeutic tasks and give medical opinions. They also participate in the management of the community psychiatric care system. The services differ widely in giving priorities to these tasks. In Germany there are no standards concerning quality and quantity of individual help being offered by SpDis. Evaluation of this individual client related help is essential for quality management. Besides rates, which partly describe the utilisation of the service, such parameters are of interest that hint at the psycho-social risk. Furthermore, figures indicating continuity or discontinuity of help are of importance. The statistics of the documentation in 1999 and 2000 of the SpDi Wolfsburg serve as an example for such an evaluation.

[Expenditures in psychiatric treatment. Is the distribution of funds according to need?]. / Ausgaben in der psychiatrischen Versorgung Ist die Verteilung der Ressourcen am Bedarf orientiert?

BACKGROUND: There is no doubt that mental health care should be geared toward evidence, cost-effectiveness, and need. Health care data that allow comparisons of demand and real needs are scarce. This is especially true for outpatient care. METHOD: The aim of this study was to assess and analyze data from health insurance plans and social welfare. RESULTS: The costs of mental health care in Germany amount to 13 mio per year and 100,000 population. Health insurance schemes account for two thirds of total costs and social welfare for one third. The distribution of expenses seems not to be based on need analyses. Especially the chronically mentally ill are disadvantaged. CONCLUSIONS: The redistribution of expenses from inpatient to outpatient care including integrated health care approaches would result in more cost-effective mental health care.

[Notes on the care of mentally ill residents in nursing homes in the Uelzen county district]. / Zur Versorgung von psychisch kranken Altenheimbewohner/innen im Landkreis Uelzen.

From 1999 to 2001 the "Centre of Applied Health Sciences" (University of Luneburg) carried out a research project in cooperation with the Psychiatric Hospital Hacklingen in Luneburg and the department of social psychiatry and psychotherapy of the Hanover College of Medicine. The project covered the prevalence of mental disorders among the residents of nursing and geriatric homes in the district of Uelzen including different aspects of medical, psychiatric and nursing care. The research was based on a survey including all residents of these institutions. The response rate was 925 of a total of 1,100 residents. Results showed that three-quarters of the residents had considerable and different psychiatric symptoms and that almost half of the residents suffered from symptoms of dementia. The provision of health care as well as nursing care for these residents are considerably deficient. Care facilities are hardly of therapeutical standard and guidelines. This refers in particular to treatment with psychoactive drugs. The (few) comparable studies show that -- with the exception of some pilot projects -- the situation in the district of Uelzen may be similar to that in other regions of Germany.

[Coenaesthesia after infection with Varicella zoster virus. The psychodynamic meaning of suffering a children's disease at adult age]. / Zönästhesie nach Varicella-zoster-Infektion. Psychodynamische Bedeutung einer Kinderkrankheit im Erwachsenenalter.

The case report is presented of a 33-year-old male who developed coenaesthesia after suffering from chickenpox. While central nervous involvement of the herpes zoster virus infection was not found, suffering a children's disease at an adult age proved an important psychodynamic factor for release of the coenaesthetic symptomatology.

[Morita therapy--a Japanese method for treating neurotic anxiety syndrome]. / Morita-Therapie. Eine originär japanische Therapieform zur Behandlung neurotischer Angststörungen.

In Japan, the traditional Morita therapy is indicated for "shinkaishitsu" personalities, i.e., patients with neurotic anxiety disorder, especially with phobic and hypochondriac symptoms. The substantial theoretical basis and therapeutic principles were taken from Zen Buddhism, such as the development of the ego in the "space" between subject and object, the unity of body and soul, the distinction of inner and outer nature, and the principles of emptiness and nothingness. The treatment consists of an initial 7-day period of strict and isolated rest in bed followed by step-by-step occupational therapy and final reintegration into job and family. The founder of this therapy, Morita, sees the healing of the patients not in the removal of their fears but in the inner acceptance (arugamama) of the fears they have experienced--corresponding to an essential principle in Zen Buddhism. Nowadays, the method is used in a modified form adjusted to the change in mentality of Japanese patients.

[Koro--discussing a transcultural psychopathological phenomenon]. / Koro--Erörterung eines transkulturell psychopathologischen Phänomens.

Koro describes a psychopathological phenomenon mainly found in Asia. It is the syndrome of an assumption of male genital shrinking. This idea is rarely described in Western culture. Inspired by a current case report--a patient, suffering from schizophrenia described Koro-like symptoms--we will discuss Koro on the basis of a literature review in its transcultural psychiatric context.

The development of a clinical syndrome of asymptomatic pancreatitis and eosinophilia after treatment with clozapine in schizophrenia: implications for clinical care, recognition and management.

Clozapine, the first atypical antipsychotic, is indicated for the treatment of therapy-resistant schizophrenia. It needs to be monitored closely because of its well-known potential side-effects, especially agranulocytosis. We present a case of a middle-aged woman with chronic schizophrenia, who was treated with clozapine and developed a clinical syndrome of asymptomatic pancreatitis and eosinophilia within the fifth week of treatment. Asymptomatic pancreatitis has rarely been reported up to now and is not recognized as a typical side-effect of clozapine. In our opinion, pancreatic enzymes should be monitored especially in the first 6 weeks of clozapine treatment.