[A case of schizophrenia simplex?]. / Ein Fall von Schizophrenia simplex?

In routine clinical work, the psychopathology of some patients makes distinct diagnosis more difficult for the psychiatrist. In schizophrenia, especially those patients with dominant autism, eccentric behaviour, and abnormalities of affect with no evidence of positive symptoms pose special diagnostic problems. We report a case with formal thought disorder, autism, altered interactional behaviour, and disturbed emotional expression with no characteristic schizophrenic perception disorders, delusions, or other positive symptoms. With the help of this exemplary case, we discuss the diagnostic dilemma in careful use of diagnostic criteria in diagnosing schizophrenia in such cases.

ICD-10 mild cognitive disorder following meningitis due to neurosarcoidosis.

We report the case of a patient referred to our department with the diagnosis of conversion disorder, who ultimately proved to have neurosarcoidosis presenting with mild cognitive disorder. Despite the criticism of mild cognitive disorder as a diagnostic entity, our patient met the criteria for it. The reported case exemplifies the difficulties in classifying mild cognitive deficits in patients suffering from brain diseases without major morphological damage.

[External quality assurance of inpatient treatment in schizophrenia. results of a multicenter study]. / Externe Qualitätssicherung der stationären Behandlung schizophrener Patienten. Ergebnisse einer multizentrischen Studie.

Due to legal regulations, external quality assurance is mandatory in Germany. Supported by the German Health Ministry (BMG), we present the results of a multicenter study in four hospitals with different structures on 1042 inpatients with the tracer diagnosis of schizophrenia (ICD 10). We defined disease-specific indicators of structure, process, and outcome quality, developed an assessment instrument, and implemented a feedback system for quality comparison. The resulting quality profiles are useful as a starting point for internal quality management.

Interdisciplinary clinical assessment of patients with illness attributed to environmental factors.

Patients with health problems attributed to environmental factors such as chemical pollutants and electromagnetic fields often do not present evidence of an environmental aetiology of their symptoms. It has been postulated, that their problems are due to disorders diagnosed by other medical disciplines, especially allergology and psychiatry. Our study was designed to subject these patients to a comprehensive diagnostic program involving several medical disciplines in order to achieve diagnoses appropriate to explain the patients' symptoms. Fifty patients consecutively referred to the department of environmental medicine in the university hospital of Aachen, Germany, were submitted to the following examinations: (i) environmental medicine (history, clinical examination, biological and/or ambient monitoring for environmental agents); (ii) allergological examination (history, clinical examination, skin tests); (iii) psychiatric examination (psychopathological examination, psychometric and neuropsychological testing). In addition, the patients were examined in other hospital departments according to the symptoms presented. The findings were discussed in case conferences attended by the physicians involved in order to achieve individual diagnoses. The numbers of patients to whom diagnoses were given by different medical disciplines are as follows: psychiatry (32 patients), dermatology (4), allergology (2), neurology (2), rheumatology (2), gynaecology (1), haematology (1). The most frequent mental disorders diagnosed by the psychiatrists were somatoform disorders (19), followed by schizophreniform and delusion disorders (7). In spite of extensive diagnostic efforts, patients with health problems attributed to the environment usually do not present sufficient evidence of an environmental aetiology of their symptoms. On the other hand the symptoms often meet the diagnostic criteria of other diseases, especially of mental disorders.

[Quality indicators of patient treatment of schizophrenic patients. Results of a pilot study for external quality assurance using tracer diagnosis]. / Qualitätsindikatoren der stationären Behandlung schizophrener Patienten. Ergebnisse einer Pilotstudie zur externen Qualitätssicherung mit Hilfe einer Tracer-Diagnose.

PURPOSE: In Germany, measures for assuring the quality of inpatient treatment are regulated by legislation. Treatment quality must be presented in comparison with other hospitals. Tracer diagnosis is an established method for external quality assurance in the sphere of somatic medicine. METHOD: To evaluate this method of external quality assurance in psychiatry, the German Society for Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) defined and operationalised quality indicators for the treatment of schizophrenic inpatients. RESULTS: of a multicentre project supported by the German Federal Ministry of Health (BMG) using this inventory in 96 schizophrenic inpatients (ICD-10) from 4 hospitals are presented. The qualification of these indicators of structure, process and outcome while comparing the treatment quality of different hospitals as well as their applicability for internal quality management are discussed.