[Deactualization and orthostrophy. Phenomenological psychopathology of receding delusions]. / Entaktualisierung und Orthostrophe. Zur phänomenologischen Psychopathologie des abklingenden Wahns.

In this article we develop a phenomenological psychopathology of receding delusions in persons with a diagnosis of schizophrenia. Drawing on Klaus Conrad's (1905-1961) descriptions of beginning schizophrenia and an in-depth single case study, we develop descriptions of the process of receding delusions as opposed to ongoing delusions in the manner of a double-orientation to reality. We distinguish two stages in this process of social recovery and term these stages deactualization and orthostrophy. We argue that delusional convictions lose importance and persuasive power if they are no longer supported by corresponding value apprehensions or perceptions and perception-like experiences (i.e. hallucinations). Consequently, we propose that the process of receding delusions proceeds in layers comparable to a regression of the process of upcoming delusions. Lastly we discuss both stages of receding delusions (deactualization and orthostrophy) and ongoing delusions (double-orientation to reality) as possible continuous manners of social recovery concerning delusional psychosis (diagnosis of schizophrenia) and argue for specific interventions according to these different continuous manners.

[In truth could nothing on earth help? Kleist's suicide from a psychiatric perspective]. / In Wahrheit auf Erden nicht zu helfen? Kleists Suizid aus psychiatrischer Sicht.

Heinrich von Kleist (1777-1811) was a German poet and dramatist. During the celebrations marking the 200th anniversary of his death in November 2011, his double suicide with Henriette Vogel on the shores of the Kleine Wannsee near Berlin was extensively and publicly debated in Germany. The meticulous reconstruction of his suicidal condition demonstrates that often only a few aspects of this condition are highlighted in German-speaking feuilleton or biographies. Contrasting the popular stylization of Kleist's suicide as a "well-defended deliberate self-killing" or a "romantic double suicide" it is argued that: (a) retrospective psychiatric diagnosis or psychological models of explanation are necessarily questionable (so-called pitfall of pathography), (b) Kleist's mental narrowness regarding suicide as a behavioral option was multifactorially motivated and (c) his sentence "The truth is that on earth no help was possible for me" clearly expresses his desperation but delivers no justification for his suicide. On the contrary, from a clinical ethical point of view suicide can only be justified if no improvement of the condition is objectively possible. Even if this would have been the case in Kleist's time, nowadays modern psychotherapeutic and pharmacological means are reliably and easily able to help people in comparable situations. With a discussion and meticulous reconstruction this paper increases the understanding of Kleist's suicide and opens a clear view on his life and works.

[Karl Jaspers : Tasks and limitations of psychotherapy]. / Karl Jaspers. Aufgaben und Grenzen der Psychotherapie.

Using Jaspers' methodically critical attitude (methodenkritische Einstellung) we distinguish three aspects of his understanding of psychotherapy: (1) psychotherapy gains scientific quality via methodical strictness (and is therefore independent of a therapist's weltanschauung); (2) psychotherapy is a (more or less) 'hermeneutical' method of self-enlightenment, offering limited statements with respect to one's life conduct; and (3) psychotherapy oversteps its epistemological limits if gaining the status of a weltanschauung, instead of leading to (existential) philosophizing in the face of transcendence. Following Jaspers we try to answer the question: What are the limits of psychotherapeutic methods with respect to questions of life conduct? The most important limit is the unbreakable linkage between the style of one's life conduct and the (personally) experienceable (superpersonal) sense of life, which cannot be disrupted with the means of any justifiable belief or falsifiable knowledge. Quite to the contrary, this existential linkage is the starting point of many psychotherapeutic interventions.

[Hölderlin--or the question of the meaning of psychosis]. / Hölderlin oder die Frage nach dem Sinn des Psychotischen.

Friedrich Hölderlin (1770-1843) is one of the most important German poets. Actual research into his life and work has shown new aspects in his thinking concerning questions about subjectivity, sense of life and psychosis. We follow these lines using a hermeneutical method. In his late poems the experience of schizophrenic alienation appears metaphorically speaking like an ebbing of a former plenitude of meanings or as if he were decentered from his own life. Hölderlin names it an "uninvolved" view onto the ordinary life. Hölderlin invites and enables us via his offer for an innerperspective understanding of the schizophrenic experience of alienation to deal fairly and respectfully with schizophrenic patients as if we were "alienists" (E. Straus).

[An anthropological view of addiction]. / Zur philosophischen Anthropologie der Sucht.

In psychiatric discourse, addiction is normally understood according to the original paradigm of "dependency" which claims lifelong and unchangeable dependency on the addictive substance or "psychotropic technique". In the attempt to reduce damage or achieve abstinency, therapeutic interests and understanding of the human mind contradict this inflexibility. This contradiction in psychiatric understanding of addiction can be viewed as a dynamic part of the addiction process. A philosophical anthropology of addiction is presented in that light. Using the concept "the psychotropic technique achieves a superior position", both sides of the psychiatric understanding are combined and integrated. The addictive mind and its self-awareness can then be understood as a "fragile monoidentity". Implications of such an understanding are discussed.

[The endogenous cannabinoid system. Therapeutic implications for neurologic and psychiatric disorders]. / Das endogene Cannabinoidsystem. Therapeutische Implikationen der Cannabinoide bei neurologisch-psychiatrischen Erkrankungen.

For about 5,000 years, cannabis has been used as a therapeutic agent. There has been growing interest in the medical use of cannabinoids. This is based on the discovery that cannabinoids act with specific receptors (CB1 and CB2). CB1 receptors are located in specific brain areas (e.g. cerebellum, basal ganglia, and hippocampus) and CB2 receptors on cells of the immune system. Endogenous ligands of the cannabinoid receptors were also discovered (e.g. anandamids). Many physiologic processes are modulated by the two subtypes of cannabinoid receptor: motor functions, memory, appetite, and pain. These innovative neurobiologic/pharmacologic findings could possibly lead to the use of synthetic and natural cannabinoids as therapeutic agents in various areas. Until now, cannabinoids were used as antiemetic agents in chemotherapy-induced emesis and in patients with HIV-wasting syndrome. Evidence suggests that cannabinoids may prove useful in some other diseases, e.g. movement disorders such as Gilles de la Tourette's syndrome, multiple sclerosis, and pain. These new findings also explain the acute adverse effects following cannabis use.

[Charles Bonnet syndrome in an elderly patient with bilateral vision loss, hyperthyroidism and relative digitalis overdose]. / Charles-Bonnet-Syndrom bei einer älteren Patientin mit beidseitigem Visusverlust, Hyperthyreose und relativer Digitalis-Uberdosierung.

Charles Bonnet syndrome (CBS) is characterized by the presence of visual hallucinations in elderly, mentally healthy people. We report a visually impaired 90-year-old woman suddenly complaining of visual hallucinations, suffering from hyperthyroidism and a relative digitalis overdose. The diagnosis of CBS could be made after the exclusion of an intoxication and other neurological and psychiatric syndromes. In this case, visual hallucinations ceased without specific psychopharmacological therapy. A brief review of this organic hallucinosis, differential diagnosis, especially hyperthyroidism-induced psychosis, and digitoxin-induced psychosis is given and current therapeutic strategies are suggested.

[Paranoia with late onset. Psychopathology and psychodynamics]. / Paranoia mit spätem Beginn. Psychopathologie und Psychodynamik.

We report on a 70-year-old man who suffered from persecutory delusions during the last 20 years. During first visits, he showed neither cognitive impairment nor Schneiderian first rank symptoms. Inpatient and day clinic treatment as well as further outpatient therapy led to reintegration into social life and trusting relationships between the patient and the therapeutic team, although the persecutory delusions still persisted. During following years, symptoms of cognitive impairment increased gradually and neurological symptoms could be observed. We present a psychodynamic hypothesis regarding the reported psychopathology and discuss alternative diagnoses and pharmacological treatment.

[Cannabis consumption and its psychosocial effects in a comparison of different cultures]. / Cannabiskonsum und seine psychosozialen Wirkungen im Kulturvergleich.

Cannabis consumption is a social and cultural phenomenon. It has a specific place in each society, therefore psychotropic effects are judged differently. In medieval Islam cannabis consumption showed connections with religious and mystic events and was basically formed through consuming sufis. The main risk of cannabis use was especially the induction of "madness" or psychotic states in case of high dosage and high frequency of consumption. Nevertheless there were no social sanctions. Today in western civilized countries cannabis consumption is connected with relaxed activity and is mainly consumed by adolescents. The main risk is seen in the ongoing consumption of illicit drugs, since cannabis consumption is widely held as the first step for such a career. On the other hand the induction of psychotic states or a schizophrenia-like psychosis is rarely named in public discussions. At all times self-reports of cannabis-users named creative aspects of cannabis-consumption, normally seen in the conscious translation into normal reality of astonishing and formerly unknown experiences made in an intoxicated state. This aspect of cannabis use is widely disregarded in scientific research. Various reasons therefore are discussed.

[Heinrich von Kleist--crisis and creative overcoming]. / Heinrich von Kleist - Krise und schöpferisches Uberwinden.

Heinrich von Kleist's life was shaken repeatedly by negative life-events, finally he committed suicide in his last life-crisis (1811). His work was mostly understood as descriptions of negative life-events and failed-being. In this article it will be shown that in at least two "crises" Kleist's work can be understood as a creative overcome of those. Kleist shows in his "Essay to Find a Sure Way to Happiness" (1799) his way of solving his "Soldier-Crisis" (1798), a depressive episode. In "The Broken Jug" (1802 - 1805) he shows the implications of a philosophical problem experienced in his "Kant-Crisis" (1801) and offers chances to overcome this particular crisis, which still seems to be an actual problem of ourselves. Though his crises must be understood as depressive episodes, at least the "Kant-Crisis" with its connections to philosophical and artistical matters seems to be more complicated than a simple depressive syndrome. Kleist formulates his basic life-experience, to be repeatedly shaken by "crises" respectively depressive episodes and the necessity to overcome each in a new way of living.

[Diagnostic steps in Alzheimer dementia before treatment with new antidimentives]. / Diagnostische Schritte bei Alzheimer-Demenz vor Therapiebeginn mit neuen Antidementiva.

The dementia of the Alzheimer type (DAT) is a chronic neurodegenerative illness. It will continue to increase because of rising life expectancy in the industrialized countries. Apart from the physicians interest to treat, there is also an economically justified interest to reduce the disease progression in this group of patients. The main intention of the treating physicians is to keep their patients independent as long as possible. Up to now Alzheimer's disease can only be treated symptomatically. The verified diagnosis of DAT still depends on the neuropathological investigation of brain tissue. Therefore the clinical diagnosis of DAT during lifetime should be supported by chemical analysis of typical changes in the cerebrospinal fluid (CSF) at an early stage. Meanwhile, several therapeutics with proven effectiveness in clinical studies are certified for the symptomatic treatment of DAT. However, these therapeutics are still relatively expansive. Due to this fact the clinical diagnosis of DAT should be supported by clinical-chemical markers before the beginning of such a treatment. In this paper we present the diagnostic steps in dementia patients, who are examined in our departments. Patients suspicious of DAT always are asked for a spinal tap in addition to other diagnostic tools. In case of a typical clinical constellation, the exclusion of a primarily vascular dementia as well as the proof of decreased A beta 1-42 peptides and an increased tau protein in CSF we recommend the new drugs for DAT as meaningful and justified therapeutics to yield optimal treatment.