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1.
Psychiatr Prax ; 46(8): 460-467, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31683336

RESUMEN

OBJECTIVE: A pilot study was conducted to test a newly developed inventory for the assessment of malpractice in psychotherapy and its consequences. We aimed to examine the frequency of boundary crossings and violations in the context of psychotherapy from a patient's perspective and the resulting burden as well as to identify potential predictors. METHODS: Data assessment was realized in an online-based survey. The final sample existed of N  = 165 patients who underwent prior psychotherapeutic treatment. RESULTS: Patients reported M = 16.21 events which can be interpreted in terms of malpractice resulting in a mediocre level of distress. While malpractice summarized as "inadequate use of diagnostics/techniques" was reported most frequently, sexual boundary violations were associated with the highest levels of distress. CONCLUSION: The results demonstrate the need of a differential and systematic assessment of malpractice in psychotherapy. The new inventory especially seems to be suited for research purposes.


Asunto(s)
Mala Praxis , Relaciones Médico-Paciente , Psicoterapia , Alemania , Humanos , Mala Praxis/estadística & datos numéricos , Proyectos Piloto , Psicoterapia/legislación & jurisprudencia , Delitos Sexuales/legislación & jurisprudencia , Conducta Sexual
3.
Psychopharmacology (Berl) ; 235(2): 591-604, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29147729

RESUMEN

Human research with hallucinogens such as lysergic acid diethylamide (LSD) has been ongoing in the USA since 1949. During the 1960s, LSD was investigated for a variety of psychiatric indications, including the following: as an aid in treatment of schizophrenia; as a means of creating a "model psychosis"; as a direct antidepressant; and as an adjunct to psychotherapy. Studies with all drugs, including LSD, have always been conducted under federal regulatory controls, including the 1938 Food Drug and Cosmetic Act (FDCA; which ensured the safety of drugs) and the 1962 Kefauver-Harris Amendments to the FDCA (which described appropriate scientific methodology and ensured drug efficacy). This paper details how the 1962 Amendments introduced numerous safety and efficacy requirements that must be in satisfied during clinical drug research-and how human studies conducted with LSD in the 1960s struggled with their fulfillment. Information is provided from Senate hearings, case law, and interviews with key investigators. Examples are also drawn from scientific papers and symposia published during and since that period, with a focus on information from clinical studies conducted with LSD by psychiatrist Albert Kurland at the Spring Grove State Hospital, near Baltimore, MD. While Kurland largely conformed with these new regulations, other investigators often fell short of complying with scientific standards and federal requirements. Thus, the human hallucinogen studies of the 1960s are best understood as providing pilot data on safety and efficacy, as well as testable hypotheses for current hallucinogen studies conducted under modern scientific and regulatory standards.


Asunto(s)
Ensayos Clínicos como Asunto/legislación & jurisprudencia , Alucinógenos/administración & dosificación , Experimentación Humana/legislación & jurisprudencia , Dietilamida del Ácido Lisérgico/administración & dosificación , Ensayos Clínicos como Asunto/métodos , Humanos , Psicoterapia/legislación & jurisprudencia , Psicoterapia/tendencias , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/psicología , Estados Unidos
4.
Nervenarzt ; 89(1): 71-77, 2018 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-28785776

RESUMEN

BACKGROUND: Recidivism rates in substance-addicted patients placed in institutions according to §64 of the German legal code are approximately 50%, 3 years after discharge from inpatient treatment. The recidivism rates of patients with premature termination of inpatient treatment who had then been referred back to prison and were finally discharged into the community are unknown. RESEARCH QUESTION: Is premature termination of treatment a risk factor for recidivism? METHODS: Patients released from forensic treatment according to § 64 of the German legal code were followed up for violent and non-violent recidivism. Full data were acquired for Baden-Württemberg patients released in 2010 and 2011 with regular vs. premature termination of treatment. RESULTS: All measures revealed highly significant group differences: 48% of the patients discharged after subsequent prison sentences recidivated within the first year and 73% within 3 years after discharge. Among recidivists, the severity of offences was much higher (odds ratio > 3.8 each). Regularly discharged patients also re-offended to a remarkable extent (50%). DISCUSSION: Patients serving prison sentences after unsuccessful forensic treatment are a high-risk group for recidivism. Alternative concepts of clinical and legal treatment of this group should be developed.


Asunto(s)
Crimen/legislación & jurisprudencia , Crimen/psicología , Pacientes Desistentes del Tratamiento/psicología , Prisioneros/legislación & jurisprudencia , Prisioneros/psicología , Psicoterapia/legislación & jurisprudencia , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Femenino , Estudios de Seguimiento , Psiquiatría Forense/legislación & jurisprudencia , Alemania , Humanos , Masculino , Estudios Prospectivos , Psicotrópicos , Recurrencia , Factores de Riesgo , Trastornos Relacionados con Sustancias/psicología
5.
Cult Med Psychiatry ; 42(2): 371-400, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28948435

RESUMEN

This article focuses on the psychotherapy debate in China that was triggered by the country's mental health legislation. Seeing the release of the draft Mental Health Law in 2011 as a "diagnostic event" (Moore in Am Ethnol 14(4):727-736, 1987), I examine the debate in order to unravel the underlying logic and ongoing dynamics of the psycho-boom that has become a conspicuous trend in urban China since the early 2000s. Drawing on my fieldwork in Beijing and Shanghai, I use the two keywords of the debate-"jianghu" (literally "rivers and lakes"), an indigenous term that evokes an untamed realm, and "profession," a foreign concept whose translation requires re-translation-to organize my delineation of its contours. I describe how anticipation of state regulation prompted fears and discontents as well as critical reflections and actions that aimed to transform the field into a profession. The efforts to mark out a professional core against the backdrop of unruly jianghu further faced the challenge of an alternative vision that saw popularization as an equally noble cause. The Mental Health Law came into effect in 2013; ultimately, however, it did not introduce substantive regulation. Finally, I discuss the implications of this debate and the prospects of the psycho-boom.


Asunto(s)
Empleos en Salud/legislación & jurisprudencia , Legislación como Asunto , Salud Mental/legislación & jurisprudencia , Psicoterapia/legislación & jurisprudencia , Población Urbana , Beijing , China , Humanos
7.
Z Psychosom Med Psychother ; 63(3): 234-250, 2017 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-28974178

RESUMEN

A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years Objectives: Both the public and the legislative have developed an increasingly critical awareness for the fact that expert witnesses need to be independent. In contrast, to date there have been few studies concerning the quantity and the results of psychosomatic-psychotherapeutic expert opinions for public and private clients. METHODS: In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). RESULTS: 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the assessment verbally. DISCUSSION: It should be emphasized that OPD conflict and structural diagnostics appear indispensable also for assessing mental health prior to an external event (accident or assault). The use of the two severity ratings (ISS, GAF) is discussed. It is proposed that expert witnesses be requested to name all their clients fromthe last 5 years at the beginning or end of the expert opinion, so that their independence from possible conflicts of interest can be established.


Asunto(s)
Testimonio de Experto/legislación & jurisprudencia , Hospitales Universitarios , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Medicina Psicosomática/legislación & jurisprudencia , Psicoterapia/legislación & jurisprudencia , Accidentes/legislación & jurisprudencia , Adulto , Conflicto de Intereses , Evaluación de la Discapacidad , Femenino , Alemania , Humanos , Masculino , Trastornos Mentales/clasificación , Persona de Mediana Edad , Estudios Retrospectivos , Violencia/legislación & jurisprudencia
9.
Soins Psychiatr ; 38(309): 12-16, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28284282

RESUMEN

In France, court-ordered therapy is a measure applicable in the framework of socio-judicial supervision, created by the law of 17th June 1998 relating to the prevention and suppression of sex offences, as well as the protection of minors. Since its introduction, its indications have been extended to include other offences. By organising a triangulation of the relations between the legal and health care systems (doctors and psychologists) through the intermediary of the doctor-coordinator, this programme aims to prevent reoffending.


Asunto(s)
Internación Compulsoria del Enfermo Mental/legislación & jurisprudencia , Conducta Peligrosa , Enfermería Psiquiátrica/legislación & jurisprudencia , Psicoterapia/legislación & jurisprudencia , Delitos Sexuales/legislación & jurisprudencia , Delitos Sexuales/prevención & control , Adulto , Niño , Francia , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Menores/legislación & jurisprudencia , Pedofilia/enfermería , Pedofilia/prevención & control , Prevención Secundaria
10.
Soins Psychiatr ; 38(309): 17-21, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28284283

RESUMEN

Faced with the increase in convictions for sex offences, legislators in the 1990s studied the possibility of monitoring these criminals and offenders, considered to be among the most dangerous, following their imprisonment. This resulted in the law of 17th June 1998, establishing socio-judicial supervision. Inspired by several high-profile cases, the resulting changes to the legislation have reinforced judicial measures aimed at preventing repeat offending with regard to the most serious crimes. Socio-judicial supervision in particular is routinely ordered as part of certain safety measures while court-ordered therapy has become a cornerstone in the management of the most dangerous prisoners. An analysis of the connection between the judge and court-ordered therapy enables its role to be better understood.


Asunto(s)
Internación Compulsoria del Enfermo Mental/legislación & jurisprudencia , Conducta Peligrosa , Comunicación Interdisciplinaria , Colaboración Intersectorial , Psicoterapia/legislación & jurisprudencia , Violencia/legislación & jurisprudencia , Violencia/prevención & control , Francia , Humanos , Consentimiento Informado/legislación & jurisprudencia , Enfermería Psiquiátrica/legislación & jurisprudencia , Medición de Riesgo/legislación & jurisprudencia , Prevención Secundaria
11.
Soins Psychiatr ; 38(309): 22-24, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28284284

RESUMEN

Doctor-coordinators are nominated by the judge for the enforcement of sentences as soon as socio-judicial supervision with court-ordered therapy is to be implemented. Their mission is to facilitate the contact between offenders and the general practitioner likely to be working with them on the therapeutic level. The experience of the doctor-coordinator in Bordeaux sheds light on the conditions in which this function is performed. Identifying elements which may be considered as indicators of the risk of reoffending is, in daily practice, a constant concern for this specialist.


Asunto(s)
Internación Compulsoria del Enfermo Mental/legislación & jurisprudencia , Conducta Peligrosa , Comunicación Interdisciplinaria , Colaboración Intersectorial , Psicoterapia/legislación & jurisprudencia , Medición de Riesgo/legislación & jurisprudencia , Prevención Secundaria/legislación & jurisprudencia , Delitos Sexuales/legislación & jurisprudencia , Delitos Sexuales/prevención & control , Francia , Humanos , Enfermería Psiquiátrica/legislación & jurisprudencia , Violencia/legislación & jurisprudencia , Violencia/prevención & control , Violencia/psicología
12.
Soins Psychiatr ; 38(309): 25-30, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28284285

RESUMEN

As is the case with other contexts of mental health treatments, the therapeutic approaches to court-ordered therapy are varied. They are based on the principle of their clinical indication and must be delivered by therapists trained in the specific area. The classic therapeutic approaches are used: medication, psychoanalysis and psychoanalytically inspired therapies, cognitive behavioural therapies, group therapies and body-oriented approach.


Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Internación Compulsoria del Enfermo Mental/legislación & jurisprudencia , Conducta Peligrosa , Psicoterapia/legislación & jurisprudencia , Psicotrópicos/uso terapéutico , Delitos Sexuales/legislación & jurisprudencia , Delitos Sexuales/prevención & control , Competencia Clínica/legislación & jurisprudencia , Terapia Combinada , Francia , Humanos , Masculino , Grupo de Atención al Paciente/legislación & jurisprudencia , Medición de Riesgo/legislación & jurisprudencia , Prevención Secundaria
13.
Soins Psychiatr ; 38(309): 31-35, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28284286

RESUMEN

Psychologists and a psychiatrist testify to the clinical condition of people sentenced to socio-judicial supervision with court-ordered therapy. Despite the extension of the indication of the programme, this complex supervision often concerns the perpetrators of intra and/or extra familial sexual abuse. Preventing reoffending through the global treatment of the patient is a major concern both for the doctor-coordinators as well as the doctor and psychologists delivering the therapy.


Asunto(s)
Internación Compulsoria del Enfermo Mental/legislación & jurisprudencia , Conducta Peligrosa , Psicoterapia/legislación & jurisprudencia , Violencia/legislación & jurisprudencia , Violencia/prevención & control , Agresión/psicología , Francia , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Masculino , Grupo de Atención al Paciente , Medición de Riesgo/legislación & jurisprudencia , Medidas de Seguridad/legislación & jurisprudencia
14.
Soins Psychiatr ; 38(309): 40-42, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28284288

RESUMEN

Following the Dutroux affair which rocked Belgium in 1996, the Belgian minister for justice signed cooperation agreements with the country's three regions (Flanders, Wallonia and Brussels-Capital), imposing on sex offenders therapy or treatment as an alternative to imprisonment. What legal programme is now in place for their management? Experience of the Brussels support centre.


Asunto(s)
Internación Compulsoria del Enfermo Mental/legislación & jurisprudencia , Conducta Peligrosa , Psicoterapia/legislación & jurisprudencia , Delitos Sexuales/legislación & jurisprudencia , Bélgica , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Masculino , Menores/legislación & jurisprudencia , Cooperación del Paciente/psicología , Enfermería Psiquiátrica/legislación & jurisprudencia , Medición de Riesgo/legislación & jurisprudencia , Prevención Secundaria , Delitos Sexuales/psicología , Socialización
16.
Nervenarzt ; 88(7): 802-810, 2017 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-27981375

RESUMEN

STUDY OBJECTIVE: A simple instrument to record case-related coercive measures was tested as part of a pilot project of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). METHODS: To assess coercive measures data were collected for 3 months in 8 German hospitals for psychiatry and psychotherapy. The type of measures used, the main diagnosis and the legal basis for the coercive measures were documented. RESULTS: In the sample studied, coercive measures were applied in 8% of cases. Coercive measures were most commonly used in patients with a schizophrenic disorder. The principle of justifiable necessity according to § 34 of the German Penal Code was used particularly often as the legal basis for justifying the coercive measures. CONCLUSION: Suitable measurement instruments and reliable data that enable the learning of best practices represent the basis for a reduction of coercive measures.


Asunto(s)
Coerción , Hospitales Psiquiátricos , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Psicometría/estadística & datos numéricos , Psicoterapia , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Estudios Transversales , Alemania , Hospitales Psiquiátricos/legislación & jurisprudencia , Humanos , Trastornos Mentales/epidemiología , Aislamiento de Pacientes/legislación & jurisprudencia , Proyectos Piloto , Psicoterapia/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Restricción Física/legislación & jurisprudencia , Esquizofrenia/epidemiología , Esquizofrenia/terapia , Psicología del Esquizofrénico , Sociedades Médicas , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia
17.
Prax Kinderpsychol Kinderpsychiatr ; 65(10): 707-728, 2016 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-27923340

RESUMEN

Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.


Asunto(s)
Técnicas de Apoyo para la Decisión , Planificación de Atención al Paciente/organización & administración , Refugiados/psicología , Trastornos por Estrés Postraumático/terapia , Adolescente , Atención Ambulatoria/ética , Atención Ambulatoria/legislación & jurisprudencia , Actitud del Personal de Salud , Niño , Árboles de Decisión , Ética Médica , Alemania , Humanos , Programas Nacionales de Salud/ética , Programas Nacionales de Salud/legislación & jurisprudencia , Planificación de Atención al Paciente/ética , Planificación de Atención al Paciente/legislación & jurisprudencia , Psicoterapia/ética , Psicoterapia/legislación & jurisprudencia , Psicoterapia/organización & administración , Derivación y Consulta/ética , Derivación y Consulta/legislación & jurisprudencia , Derivación y Consulta/organización & administración , Refugiados/legislación & jurisprudencia , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología
20.
Nervenarzt ; 87(4): 367-75, 2016 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-26992908

RESUMEN

BACKGROUND: The European Union (EU) regulation 1901/2006 plus the implementation of pediatric investigational plans by the European Medicines Agency (EMA) have contributed to more clinical studies in pediatric psychopharmacology. A new drug market law (AMNOG) has been in force in Germany since 2011 that requires an additional process of assessment of benefits of newly authorized medications by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G­BA), which also holds for medications licensed for pediatric populations. OBJECTIVES: Summary of early assessments of benefits for newly registered compounds in the treatment of psychiatric disorders and critical discussion from the perspective of child and adolescent psychiatry. MATERIAL AND METHODS: Application and critical review of documents and written statements by various institutions and stakeholders related to assessment procedures and respective decisions by the G­BA for these medications. RESULTS AND CONCLUSION: Clearly differing requirements for study designs and outcome parameters characterize the conditions for market authorization and for the assessment of benefits. Further adjustments to the regulations in implementing the AMNOG appear to be essential, integrating agencies involved so far, complimented by expertise from regulatory agencies and medical scientific societies.


Asunto(s)
Psiquiatría del Adolescente/legislación & jurisprudencia , Psiquiatría Infantil/legislación & jurisprudencia , Industria Farmacéutica/legislación & jurisprudencia , Reforma de la Atención de Salud/legislación & jurisprudencia , Comercialización de los Servicios de Salud/legislación & jurisprudencia , Psicofarmacología/legislación & jurisprudencia , Aprobación de Drogas/economía , Aprobación de Drogas/legislación & jurisprudencia , Europa (Continente) , Alemania , Reforma de la Atención de Salud/economía , Legislación de Medicamentos , Comercialización de los Servicios de Salud/economía , /legislación & jurisprudencia , Psicoterapia/economía , Psicoterapia/legislación & jurisprudencia , Psicotrópicos , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia
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