Was King Ludwig II of Bavaria misdiagnosed by Gudden and his colleagues?

In 1886, Bernhard von Gudden and three other expert psychiatrists diagnosed the Bavarian King Ludwig II with "paranoia (madness)," a diagnosis that the Bavarian government used to justify removing Ludwig from power. Although Ludwig was not evaluated in detail by the psychiatrists, in their opinion, sworn eyewitness accounts and general knowledge about Ludwig's behavior provided sufficient grounds for the diagnosis. Ludwig was a great admirer of the musician, Richard Wagner, and shared some of his ideas of an idealistic society. At first, he identified with Wagner's opera heroes, and he became Wagner's patron sponsor for life. However, he grew increasingly interested in an absolutist state, envisioning himself as a monarch with a role similar to that of Louis XIV. His multiple building projects, for which he incurred much debt, his conviction that he was descended from the Bourbons through baptism, his increasingly abnormal behavior, and his hallucinations together formed the basis for the psychiatrists' diagnosis. Although not mentioned in the expert opinion, Ludwig's homophilic behavior-a scandal at the time-was probably also an important reason for his removal from office. A review of the psychiatric knowledge and societal philosophy of the time indicates that the psychiatrists were correct with their diagnosis in their time.

[The report on Ludwig II by Gudden and his colleagues in relation to the state of knowledge at that time]. / Guddens Kollegiatsgutachten über Ludwig II. im Wissen seiner Zeit.

Bernhard von Gudden and his prominent co-experts Grashey, Hagen and Hubrich wrote an expert opinion on Ludwig II that was based on statements of sworn witnesses of the 41-year-old monarch's pathological behavior. With the contemporary material available today it can be understood why Gudden reached the diagnosis of "paranoia (madness)", which was in accordance with the state of psychiatric knowledge at that time. Even the official investigations initiated after the deaths of Ludwig II and Gudden did not come to a different conclusion. Gudden was a highly respected physician, researcher and clinical teacher; however, in the treatment of Ludwig he misjudged the consequences of his diagnosis and they both paid for his miscalculation with their lives. The Bavarian royal tragedy has many roots but a negligent or even deliberate misdiagnosis is not one of them.

Mobility behaviour and driving status of patients with mental disorders - an exploratory study.

BACKGROUND: Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored. METHOD: Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire. RESULTS: 67% of PPs (89% NPs) reported to have a valid driver's licence and 77% of them (92% NPs) reported to regularly use their cars. Within driver's license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder. CONCLUSION: Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.

Robert Schumann in the psychiatric hospital at Endenich.

Robert Schumann (1810-1856) spent the last two-and-a-half years of his life in the private psychiatric hospital in Endenich. His medical records emerged in 1991 and were published by B. R. Appel in 2006. Daily entries document the treatment typical at that time for what was at first considered to be "melancholy with delusions": Shielding from stimuli, physical procedures, and a dietary regimen. The feared, actual diagnosis, a "general (incomplete) paralysis," becomes a certainty in the course of the paranoid-hallucinatory symptoms with cerebro-organic characteristics and agitated states, differences in pupil size, and increasing speech disturbances. In the medicine of the time, syphilis is just emerging as the suspected cause, and the term "progressive paralysis" is coined as typical for the course. Proof of the Treponema pallidum infection and the serologic reaction is not obtained until 1906. People close to Robert, in particular his wife Clara and the circle of friends around Brahms and Joachim, cared intensively for him and suffered under the therapeutic isolation. The medical records and illness-related letters contradict the theory that Schumann was disposed of by being put into the psychiatric hospital; they show the concern of all during the unfavorable illness course.

[Dementia and music]. / Demenz und Musik.

Patients suffering from dementia are nevertheless still able to render exceptional musical performances. For example, they can recognize music from childhood and reproduce lyrics and melodies of songs with four verses. Furthermore, behavioural symptoms such as psycho- motor agitation and crying, but also aggressive behaviour can be positively influenced by music and motivation and positive emotions can be increased. A variety of physiological and psychological changes occur when patients are listening to music. Previous research could show that music activated different parts of the brain especially in the temporal cortex, but also motoric areas in the frontal cortex, thalamus and cerebellum were essential for rhythm, melody and harmony perception and processing. Music therapy is an interpersonal process in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals with various psychiatric or medical conditions. However, until now only little research has been directed towards non-pharmacological treatments like music therapy in dementia patients. Further research is warranted to investigate the long term influence of music therapy on patients suffering from dementia.