[Prescription patterns and quality of information provided for consumers of benzodiazepines]. / Verschreibungs- und Aufklärungspraxis bei Benzodiazepinkonsumentlnnen.

The long-time benzodiazepine use by a considerable part of the population and its adverse consequences such as somatic and cognitive side effects, interactions with other drugs and alcohol and its possible impairment of quality of life has provoked a critical discussion about the practice of prescribing benzodiazepine and the information provided by physicians. We therefore investigated these issues in admitted patients of a general hospital. All patients having been admitted to the department of Internal Medicine and taking benzodiazepine were asked by means of a semi-structured interview, which was repeated after 1 year. In 90% of later benzodiazepine discontinuers and in almost 50% of benzodiazepine continuers, tranquilisers were first prescribed during hospital admission. Only 2% of all patients estimated the information provided by the prescribing physicians as satisfying and about 2/3 reported that they did not get any information at all. 66% of all patients were informed about dependency risks. This information was mainly provided by pharmacies, friends and patient information leaflets; only about 20% of all patients were informed by the prescribing physician. Guidelines for tranquiliser prescription only seem to have a poor impact on the clinical practice. The education of physicians about the risks of low-dose dependencies and especially about complementary therapy methods needs to be improved.

Delusions in first-admitted patients: gender, themes and diagnoses.

Whether there is a specific link between certain delusional symptoms and particular etiologies has not yet been completely clarified. In this study, 639 first ever admitted deluded patients were investigated in order to find out whether age and gender are associated with certain delusional contents, whether age at first admission may be linked to certain etiologies and whether it is possible to detect indicators particularly related to basic dysfunctions. At first admission, delusional female patients were older than men with a significant predomination of delusions of persecution, while men presented significantly more frequently delusions of jealousy and grandiosity. Within delusions of persecution, of religious or metaphysical content and of grandiosity, women were even significantly older than men. Religious or metaphysical and grandiosity contents occurred significantly more frequently in ICD-8 schizophrenia, indicating that these themes seem to be particularly linked to ICD-8 schizophrenia. Additionally, some target symptoms not included in the delusional symptomatology were investigated to test the relationship between delusions and schizophrenia. Overall, the results of the present investigation indicate that delusions are not specific for schizophrenia, and therefore, other symptomatological criteria should be applied for the nosographic attribution.

[Mentally ill and dangerous? Attitudes of female journalists and medical students]. / Psychisch krank und gefährlich? Einstellungen von Journalistlnnen und Medizinstudentlnnen.

OBJECTIVE: The realisation of community mental health services may be adversely affected by society's prejudices about mentally disordered people. In this regard, the frequently replicated stereotype that people with mental illness are dangerous is of paramount relevance. METHODS: Journalists and medical students were asked by means, of an interview whether they consider certain crimes (murder, rape, arson, larceny, disorderly conduct) to be more frequently committed by mentally disordered persons or by the general population or whether no difference is supposed. RESULTS: Journalists and medical students agreed about the frequency of commitment concerning offences such as murder (no difference between the mentally disordered and the general population), arson (more frequently committed by mentally disordered persons) and larceny (more frequently committed by the general population). While almost half the journalists supposed that there is no difference between mentally disordered persons and the general population regarding rape and disorderly conduct, just as much medical students charged mentally disordered persons with these offences. Personal contact to people with mental disorders slightly influenced these attitudes to the credit of mentally disordered persons. CONCLUSIONS: Compared with the results of a representative survey among the general population of the old Länder of Germany in 1990, journalists asked in our investigation markedly less often charged mentally disordered people with murder, rape and disorderly conduct. Medical students, in contrast, shared the general population's attitude except for murder.

A comparison of patterns of tranquiliser intake, anxiety and health locus of control between short- and long-term benzodiazepine users.

This study investigates the impact of physical illness, health locus of control and anxiety level on long- and short-term benzodiazepine (BZD) use in patients of an internal medicine department. There was no significant difference observed between the continuing and discontinuing group after hospital admission in terms of average daily dose of BZD. However, the continuing patients rated the condition of their somatic illness significantly higher than the discontinuing group, although this difference was not confirmed by the objective assessment of the treating physician. The non-continuing group displayed significantly higher control over health- and sickness-related events. The somatic and physical anxiety factor was significantly higher in the continuing group at initial investigation as well as at follow-up. On the basis of these results, we conclude that an increased focus on the psychosomatic element might reduce the risk of long-term tranquiliser use in patients with physical illness.

The gender gap in depression reconsidered: the influence of marital and employment status on the female/male ratio of treated incidence rates.

BACKGROUND: The consistently observed predominance of female over male rates in depression - in treated as well as in untreated populations - has never been satisfactorily explained. Among the many possible biological and psychosocial explanations, marital and employment status have not been extensively studied and virtually nothing is known about the combined effect of these variables on sex differences in depression. A main reason for this lack of knowledge is the limited number of cases available in epidemiological studies. METHODS: The present paper examines the combined effects of marital and employment status on sex differences in depression rates by analysing in-patient admission rates of all depressed patients aged 18-67 admitted for the first ever time to the Department of Psychiatry of the University of Vienna from a strictly defined catchment area over a period of 42 months. Stepwise Poisson regression analyses were carried out in order to identify the relative contribution of these variables to the variance of first ever in-patient admission rates for depression. RESULTS: A total of 2599 depressed patients fulfilled the inclusion criteria. When analysed separately, sex, marital status and employment status were shown to have distinct influences, with the "not married" carrying a two-fold higher risk than the married (2:1), and female sex (1.7:1) as well as not being employed (1.7:1) showing similar but smaller effects. In the detailed combined analysis, marriage was significantly less advantageous for women than for men, while sex differences disappeared completely in the widowed group. Also, there was no sex difference in the employed divorced; in the employed widowed there was even a slight preponderance in men. The highest rates were found in not employed divorced women, the lowest in employed married men. CONCLUSION: While in-patient admissions are certainly selective in relation to epidemiological data, the large sample made it possible to perform combined analyses of sex, marital status and employment status. It was shown that the statement of a female preponderance in depression, which was found for the total sample, is a gross oversimplification. If marital and employment status are considered simultaneously, the sex differences disappear in some subgroups and in some are even reversed. We suggest that the combined influence of marital and employment status should be studied in epidemiological studies as well before conclusions about the influence of sex on depression rates are drawn.

Wrapped in silence: psychotherapists and confidentiality in the courtroom.

The impact of the Austrian Psychotherapy Act, which, in contrast to legal provisions in the United States, does not provide for any exceptions to breach confidentiality, is compared with the effects of U.S. law on dealing with confidentiality. The authors investigated the impact of this law in light of three common situations in psychotherapy that may jeopardize strict confidentiality: treating potentially dangerous patients, giving testimony, and serving as a psychotherapist in prison. Under the strict provisions of the Austrian Psychotherapy Act, a breach may be excusable in the case of a highly probable danger, but Austrian psychotherapists cannot be obliged to serve as witnesses or as experts in civil or criminal cases, as American psychotherapists can. Psychotherapy in prison, where release is contingent on the success of the therapy and the divulging of information could be in the interests of the patient as well as the court and the public, requires a modified dealing with confidentiality.

Discriminating among incarcerated sexual offenders by their perception of interpersonal problems and experience-related anxiety.

Fifty-seven (57) incarcerated sex offenders were assessed for their capacity to perceive interpersonal difficulties and experience related anxiety. The findings suggest that the men who have sexually transgressed against minors view themselves as easily exploitable and nurturant, and those who have sexually aggressed against adult females demonstrated minimal regard for external negative views of them. These two groups did not differ significantly from each other along social avoidance and non assertiveness dimensions. Assertiveness was found to decrease as a consequence of multiple incarcerations in both groups. Furthermore, perception of interpersonal difficulties and experience related anxiety in our study correctly classified 72% of high and low violent sexual offenders.

[Is depression a women's disease?]. / Frauenkrankheit Depression?

The female preponderance in depression is one of the most robust findings in psychiatric epidemiology. The pertintent hypothesis of a possible role of biological and psychosocial factors and their relevance for the explanation of this gender gap are presented and discussed. Available data suggest that biological factors seem to exert an influence on the emergence of depression, but are unlikely to account for the gender differences in morbidity rates. Considering psychosocial factors like age, marital and employment status indicates that the claim that depression is more frequent in women is an oversimplification. There are groups were due to these variables no gender gap or even higher rates for males are observed.

[Social networks and social support in a sample of mentally ill sex offenders]. / Soziales Netzwerk und die Erfüllung sozialer Bedürfnisse bei Sexualstraftätern im Massregelvollzug.

OBJECTIVE: Characteristics of social networks and social support were investigated in a group of 35 imprisoned mentally ill sex offenders. METHODS: We compared current parameters (after an average of 3 years of psychosocial therapy) with those at the time of the offence. RESULTS: Analyses reveal a decrease in social network size but an increase in social support by the remaining or new social network members. These changes are discussed in reference to various influencing variables in a therapeutic prison facility. The impact of psychosocial interventions in relapse prevention of sexual offenders will be outlined.

[Assessment of experimentally-induced pain effects and their elimination by hypnosis using pupillometry studies]. / Erfassung von experimentell induzierter Schmerzwirkung und ihre Ausschaltung durch Hypnose mit Hilfe pupillometrischer Untersuchungen.

Hypnotherapeutical technique were often used for control of pain. However, an objective examination of this phenomenon was seldom carried out. The aim of the study was the psychophysiological objectivation of the effect of experimental induced pain and the elimination of pain by means of hypnosis. 22 healthy volunteers (11 female and 11 male) aged between 22 and 35 years participated in the study. In the 1st phase of the experiment static pupillometry was carried out before randomized presentation of a light stimulus (143 lux, 0.3 sec) and of a pain stimulus (coldness-spray, -50 degrees C, 0.5 sec) respectively. Afterwards the dynamic pupillary measurement was done. Additionally the Fourier analyses of pupillary oscillations reflecting central nervous activation during the static measurement (25,6 sec) was calculated. In the 2nd phase the subjects were investigated by means of the same techniques during hypnosis with specific suggestions for elimination of pain. Under light condition as well as after induction of pain an autonomic deactivation could be observed during hypnosis. Furthermore under pain condition a central deactivation could also be found, reflecting the depth of the hypnosis and the reduced perception of pain.