Depression and cognitive functioning in alcoholism.

AIMS: Studies on cognitive processes in alcoholism have reported changes with respect to executive functions and memory, which have been interpreted within the context of different neuropsychological models. The aims of the present study were to investigate (1) the validity of these models and (2) the influence of depression on cognitive functioning in alcoholism. DESIGN, SETTING AND PARTICIPANTS: In the present investigation, patients suffering from alcoholism (Alc; n = 30), patients with depression but without alcoholism (Dep; n = 28) and healthy controls (HC; n = 28) were compared on a neuropsychological test battery. MEASUREMENTS: The test battery included measurements of mood, memory and executive functions. The possible cumulative effect of alcohol and depression was analysed by comparison of depressed alcoholic patients (Dalc) and non-depressed alcoholic patients (NDAlc). FINDINGS: Group comparisons revealed impairments of alcoholic patients with respect to response inhibition, reasoning and free recall, irrespective of depression. Priming, short-term memory as well as verbal fluency abilities were unaffected. Depressive patients showed verbal fluency as well as free recall deficits. However, there was no difference in performance between depressed and non-depressed alcoholics. CONCLUSIONS: The specific pattern of neuropsychological deficits of the alcoholic patients supports the frontal lobe hypothesis. The results of the present investigation suggest that these deficits are not generally exacerbated by comorbid depressive symptoms. Further studies, however, are desirable to investigate the relation between executive deficits and depression in alcoholics with evidence of major depression.

[Health economics and evaluation of schizophrenic psychoses in Germany]. / Gesundheitsökonomische Evaluationen schizophrener Psychosen in Deutschland.

This paper presents a survey of economic analyses of schizophrenia in Germany. A recently published cost-of-illness study demonstrates the high financial burden to society caused by the disease. Ambulatory care and medication were remarkably less costly than in-patient treatment. Several other studies show that continuous in-patient treatment is less cost-effective than complementary care in the community. Two pharmaco-economic models evaluate drugs with special focus on long-term treatment. Drugs with better compliance rates seem to produce savings in the health care system by less hospital admissions, even if the drug is more expensive than other medication. In addition to the survey the problems of economic analysis of psychiatric disorders in Germany are discussed. There are difficulties caused by the structure of the German health care system. Other problems emerge from the measurement of outcomes, effectiveness, utilities and quality of life in psychiatric disorders.

[Direct and indirect costs of schizophrenia]. / Die direkten und indirekten Kosten der Schizophrenie.

In the present study the costs of schizophrenia in Germany were studied using the "bottom up" prevalence-based method. In a random sample of 180 schizophrenic patients stratified according to the most important care institutions, direct and indirect costs were retrospectively documented for a 12-month period. Depending on the place of recruitment and the extent of care provided, total yearly costs result between about DM 33,000 for a patient treated predominantly on an outpatient basis and about DM 126,000 for a patient requiring hospital care and about DM 135,000 for a patient in job rehabilitation. The direct yearly treatment costs were, as expected, lowest for patients recruited in the private practice of a psychiatrist and predominantly treated on an outpatient basis (DM 5,788), and were the highest in the psychiatric hospital (DM 64,661) and in job rehabilitation (DM 79,996). In the patients recruited in the outpatient domain, doctors' fees and medication together were responsible for only 4.5% of the total costs, whereas the indirect costs (e.g., through work incapacity) were responsible for 87% of the total yearly costs. For methodological reasons the total costs caused by schizophrenic psychoses in Germany per year can at present be estimated only roughly. A conservative estimate is between 8.5 and 18 billion DM per year. The study shows that schizophrenia is a very expensive illness, the direct and indirect costs of which are on the whole comparable to those of the common somatic illnesses. Therefore, also for economical reasons, sufficient financial means should be invested in the research and treatment of this severe illness.

[Depression in general practice of the internist and family physician]. / Depressionen in der Praxis des Internisten und Allgemeinmediziners.

Successful approach to depressed patients demands some knowledge of psychopathology, nosology and psychopharmacology. Some important aspects for practitioners of understanding and coping with depressives are given. An overview on the role of antidepressants (TCAs, selective serotonin re-uptake inhibitors, MAO-inhibitors) is also given.

[Quality assurance in the psychiatric hospital--joint medical-pharmaceutical visits]. / Qualitätssicherung im psychiatrischen Krankenhaus--gemeinsame ärztlich-pharmazeutische Visiten.

The authors report on two years of experience collected during jointly performed medico-pharmaceutical visits in a psychiatric hospital. From the viewpoint of quality assurance and quality control such a procedure has now gained topical importance. Attention is drawn to problematic drug regimens and interactions between drugs.

[Waldheim--the difficult task of investigation]. / Waldheim--Der schwierige Versuch der Aufarbeitung.

This is a report on a mental hospital--or, rather, a department of a mental hospital--called "Waldheim", (literal meaning: "hostal, or home in the woods") which is a section of the mental hospital at Hochweitzschen in Saxony in the former German Democratic Republic (GDR). Public opinion had been aroused some time ago by an article published in the German weekly "Stern" in which it was stated that psychotic patients were being subjected to leukotomy or stereotactic surgery, and that castration by x-ray treatment was being performed in mentally handicapped women, in that hospital. The article prompted the then Ministery of Health of the GDR to constitute an "expert committee" to investigate into the matter. The magazine's allegations were partly confirmed by the committee. The GDR parliament then constituted a "special parliamentary commission" for another inquiry. Again several allegations were confirmed. It was stated that the events and actions in that hospital had been unsatisfactorily assessed and digested. The authors undertake to make the procedures followed by the medical and nursing staff, accessible to a wider public and to render them more lucid. Important structural characteristics of the patterns that developed there, were the governmentally prescribed segregation of severely diseased persons to "treat" them far away from their residential community, the absence of a critical general public, and the amalgamation of supervisory institutions with those that require to be supervised.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects and side effects of depot neuroleptics as perceived by patients]. / Wirkungen und Nebenwirkungen der Depot-Neuroleptika im Erleben des Patienten.

A relatively wide acceptance of neuroleptic depot medication was seen among the patients of a large psychiatric hospital on the occasion of a survey conducted on a randomly chosen day. Patients described their experience of undesirable side effects. A basic common trait of disturbances of the feeling tone caused by depot neuroleptics was the simultaneous occurrence of conflicting emotions. Complaints by patients treated with depot neuroleptics about undesirable side effects can thus be better differentiated from their experience of the underlying psychotic disease and certain forms of experience that are typical of the personality concerned.

[Social and clinical factors in the frequency of ambulatory patients visiting a therapeutic club of a psychiatric clinic]. / Soziale und klinische Einflussgrössen auf die Besuchshäufigkeit ambulanter Patienten im therapeutischen Klub einer psychiatrischen Klinik.

Extramural psychiatric facilities such as therapeutic clubs are of major importance for the continuous aftercare of patients with qualitative or quantitative communicative difficulties. This contribution reports on social and clinical factors affecting the frequency with which outpatients of a psychiatric clinic attend such a club. The main objective of the club was to secure most frequent attendance among patients living without partners and who are not or only partly able to practice a vocation (regardless of the nosological and syndromatological diagnosis). This target was achieved. Attendance was less satisfactory among patients who had suffered from serious psychic disorders entailing frequent hospitalization and patients who, during their last stay at hospital, had received only somatic but no sociotherapeutic and psychotherapeutic treatment.

[The effect of the therapeutic milieu in the psychiatric hospital on the communication behavior of discharged psychiatric patients with one another]. / Der Einfluss des therapeutischen Milieus im Psychiatrischen Krankenhaus auf das Kommunikationsverhalten entlassener psychiatrischer Patienten untereinander.

The effectiveness of a social-psychiatrically orientated clinic was compared to a traditionally led ward on the communication behaviour of discharged patients. The random test of the questionnaire study included 120 patients. Patients of the two establishments who had experienced one or several depressive phases showed no differences. Patients with the diagnosis "schizophrenia" from the social-psychiatrically working clinic showed significant differences in the strived-for and actually realised communication behaviour compared with the more communicatively impaired patients with the same diagnosis of the ward run according to traditional practice.

[Early history of cardiological diagnostics]. / Aus der Frühgeschichte der kardiologischen Diagnostik.

The history of modern cardiology begins with William Harvey, the history of cardiodiagnostics, however, with William Heberden and the inaugurators of percussion and auscultation. Nearly all methods needed a long initial period, before they stood the test as routine measures. The revision of positive judgments of their value became necessary whereever new methods entered into competition with techniques which proved their value for long years and which apparently could not be renounced. Up to now schemes of thinking remained characteristic for the heart, the historical basis of which was shown in the present paper.

[Casuistic contribution to the differential diagnosis of the myoclonic syndrome]. / Kasuistischer Beitrag zur Differentialdiagnose myoklonischer Syndrome.

Involuntary muscle twitches, which are accompanied by a more or less pronounced effect of motion and which may last for several hours, are a common guiding symptom of a number of neurological syndromes. This paper reports the case of a 24-year-old male who had been suffering since his sixth year from episodic muscular spasms accompanied by attacks of petit mal. These are regarded as representing a myoclonic-epileptic syndrome. In this connection, a distinction has to be made, by differential diagnosis, between the "true" myoclonic syndrome which is characterized by the absence of complications due to attacks of grand mal or petit mal, Kojewnikoff's epilepsy, and the myoclonic-epileptic dementia form of syndrome.