Pharmacological Studies in Eating Disorders: A Historical Review.

Eating disorders (EDs) are serious mental health conditions characterised by impaired eating behaviours and nutrition as well as disturbed body image, entailing considerable mortality and morbidity. Psychopharmacological medication is an important component in the treatment of EDs. In this review, we performed a historic analysis of pharmacotherapeutic research in EDs based on the scientific studies included in the recently published World Federation of Societies for Biological Psychiatry (WFSBP) guidelines for ED treatment. This analysis focuses on early approaches and trends in the methods of clinical pharmacological research in EDs, for example, the sample sizes of randomised controlled trials (RCTs). We found the development of psychopharmacological treatments for EDs followed advancements in psychiatric pharmacotherapy. However, the application of RCTs to the study of pharmacotherapy for EDs may be an impediment as limited participant numbers and inadequate research funding impede generalisability and statistical power. Moreover, current medication usage often deviates from guideline recommendations. In conclusion, the RCT model may not effectively capture the complexities of ED treatment, and funding limitations hinder research activity. Novel genetically/biologically based treatments are warranted. A more comprehensive understanding of EDs and individualised approaches should guide research and drug development for improved treatment outcomes.

[Psychiatric Rehabilitation in the GDR against the Background of Soviet Influences]. / Die psychiatrische Rehabilitation in der DDR vor dem Hintergrund sowjetischer Einflüsse.

The study describes developments and local models of psychiatric rehabilitation in the GDR and the USSR. After the Second World War patient care was focused on hospitals. The Rodewisch Theses and the Brandenburg Theses as well as the "Conception to improve the patient care for mentally ill people after 1980" were important suggestions. The GDR primary literature review shows that soviet concepts were often received. The principles of stages, continuity and sectorization set the stage for success here and there. Transition units such as psychoneurological dispensaries, the occupational/protected workshops and assisted residences, therapeutic clubs, day and night hospitals were created. The occupational therapy was intended to facilitate the transition into the normal working. As a consequence, during the 1970s and 1980s in the GDR a high level of employment of mentally ill people in the economy could be achieved.

[The Therapy of Anxiety Disorders Around 1900. Hermann Oppenheim (1858-1919) and his Early Innovations]. / Die Therapie von Angststörungen um 1900. Hermann Oppenheim (1858­1919) und seine frühen Innovationen.

As a teacher and textbook author in psychiatry, Oppenheim initially received high national as well as international scientific recognition. In 1892, with his monograph on traumatic neurosis, which he regarded as the result of organic or molecular changes, his views became increasingly controversial and were met with rejection from the specialists of his time. mainly from German colleagues, probably not least because of his Jewish origin. Less historical attention, however, has been paid to Oppenheim's examination of the phenomenon of anxiety, which at his time was still a poorly elaborated pathological disorder. In his work, Oppenheim considered anxiety disorders to be an etiologically multifactorial disease and a syndrome in their own right. Oppenheim not only oriented himself towards common treatment methods such as dietetics or psychoanalysis but also considered the patient with his multi-dimensional problems as an individual deserving respect. What was more, he also applied self-developed psychotherapeutic treatment methods that show similarities with cognitive behavioral therapy that is predominantly used for anxiety disorders today. Oppenheim's work on anxiety disorders can be considered as highly innovative for his time.

[Using electricity to combat headache : Electrotherapy and tDCS in the 1870s/1880s and today]. / Mit Strom gegen den Kopfschmerz : Die Elektro- und tDCS-Therapie der 1870er-/1880er-Jahre und von heute.

Headache can be a widespread symptom as well as a disorder in itself. Headache syndromes such as migraine cause a lot of distress, disability and overall socioeconomic costs. Pharmacological treatments are often limited in their efficacy as well as due to side effects. The therapeutic application of electricity for this medical indication was a relevant field of research in the 19th century and-in the form of transcranial direct current stimulation (tDCS)-is still widely studied today. This paper provides an overview of publications from the late 19th century (as the era of discovery and success of electrotherapy) as well as contemporary studies investigating the usage of weak currents for the treatment or prophylaxis of headache. Our results show a large number of highly favorable reports of treatment successes. However, the number of cases analysed is often rather small and the forms of electric stimulation applied were often highly heterogeneous. In summary, electric stimulation appears to be a promising field of research and a possible therapeutic agent for the treatment of headaches; however, further research is necessary, especially into the details of the stimulation techniques applied and the various indications in which it may be of use.

[The 'Tabes Syphilis Controversy' : A Dispute About the Cause of Tabes Dorsalis and Progressive Paralysis at the End of the 19th Century]. / Der 'Tabes-Syphilis-Streit' Ein Disput über die Ursache der Tabes dorsalis und der progressiven Paralyse am Ende des 19. Jahrhunderts.

For some years now, the incidence of syphilis and neuroluetic clinical pictures has been increasing. As a result, tabes dorsalis and progressive paralysis are once again gaining relevance in neurology. In the last two decades of the 19th century, there was a heated debate in German neurology about the understanding of the aetiology of these conditions, the so-called 'tabes syphilis controversy'. In 1879, Wilhelm Erb had called on the German neurological community in a much-noticed lecture to finally tackle the problem to unequivocally identify the cause of tabes dorsalis. Mainly on the basis of disease statistics he himself postulated a previous syphilitic infection as of key importance. Answering this question was urgent, because the proportion of patients in psychiatric institutions suffering from progressive paralysis, to which tabes was seen in close parallel, was rapidly increasing. The Berlin neurologists Carl Westphal, Ernst Julius Remak, Martin Bernhardt and Ernst Victor von Leyden regarded Erb's thesis as a gauntlet. They saw the causes of tabes and progressive paralysis in social impoverishment such as damp and cold living conditions, in physically one-sided work overloads or in the hardships of soldiers in the army. They assumed that traumatic tabes was caused by concussions or bruises. The Leipzig neurologist Paul Julius Möbius was the first to state between 1890 and 1897 that the only cause of tabes and progressive paralysis was a previous syphilitic infection. He consistently ruled out all other aetiological theories. Above all, bacteriological and microbiological research in the following years proved Möbius right. Thus 40 years after Erb's lecture, in addition to diagnostic, specific therapeutic approaches could be developed and applied.

[Forensic Psychiatry in the GDR: An overview]. / Die Forensische Psychiatrie in der DDR. Ein Überblick.

In the discussion of medical history of psychiatry in the GDR, little attention has been paid to the subfield of forensic psychiatry. In the following literature-based overview, essential aspects of this specific topic are therefore presented. The content-related discussion in this field took place in particular in the area of forensic psychiatric expertise in criminal law, to which, among others, the most well-known forensic psychiatrist of the GDR, Hans Szewczyk, made important contributions. After the introduction of the Criminal Code in 1968 and the accompanying legal changes regarding reduced or abolished criminal responsibility of delinquents, a discourse took place until the beginning of the 1980s on various questions on the improvement of the quality of expert opinions and further development of their work. The focus was on the assessment of criminal responsibility rather than on the assessment of prognosis, which probably resulted from the abolition of the "Maßregelvollzug" in 1968. Only a few sources refer to the placement and treatment of forensic psychiatric patients. Mentally ill offenders were hardly ever accommodated in specific departments, which were apparently established in a few clinics from the mid-1970s onwards. There was also a lack of specially developed structural treatment concepts specifically for forensic psychiatric patients. Especially for mentally ill lawbreakers with a high level of delinquency, inpatient placement was apparently hardly possible due to a new legislation after 1968. In the area of civil law, only a few sources indicate that the topics of incapacitation and guardianship were addressed.

["Impulsive insanity" according to Emil Kraepelin : A clinical framework for female criminals at the beginning of the twentieth century]. / Das "impulsive Irresein" nach Emil Kraepelin : Ein Krankheitsbild für die Verbrecherinnen am Beginn des 20. Jahrhunderts.

BACKGROUND: In his comprehensive classification of the beginning of the twentieth century, Emil Kraepelin provided a detailed description of an entity he called "impulsive insanity", which had not been elaborated before him. The forms depicted by him largely corresponded to the offences, which were referred to as typically female in their nature in the late nineteenth and early twentieth centuries. QUESTION: How did Kraepelin classify "impulsive insanity" and what forms did he describe? Did Kraepelin also see these disorders predominantly prevailing in women, did he establish a connection with women's criminality and how did this fit into the discourses of the time on femininity, criminal legislation and degeneration? MATERIAL AND METHODS: This study focused on the clinical picture "impulsive insanity" as described by Emil Kraepelin in his main work, the 8th edition of his Textbook of Psychiatry published between 1909 and 1915. His description was analyzed in detail and embedded in a historical context on the basis of secondary literature. RESULTS: In rudiments Kraepelin's clinical classification is still comprehensible today, although there are major differences to how literature in later years treated this issue. Kraepelin clearly sees "impulsive insanity" as a driving disorder predominantly prevailing in women. DISCUSSION: Elaborating his concept of "impulsive insanity", Kraepelin positioned himself in relation to important scientific discourses of the early twentieth century, such as the debate on criminal legislation and the theory of degeneration. On the basis of the individual forms of "impulsive insanity" described by Kraepelin, various concepts of constructing and pathologizing femininity can be identified. Apparently, it also aims to explain common female crimes within the patriarchal hegemony.

[The "Hilfsverein für Geisteskranke" in the Kingdom of Saxony, a Philantropic Organisation for the Mentally Ill]. / Der Hilfsverein für Geisteskranke im Königreich Sachsen.

This article provides an overwiew of the history of the "Hilfsverein für Geisteskranke" in the Kingdom of Saxony (later Free State of Saxony) from its foundation in 1898 until its probable dissolution during World War II. The "Hilfsverein" was a philantropic organization that aimed to provide support for the mentally ill and their relatives through financial aid and education. It relied on a network of representatives spanning all of Saxony´s regions. Its work continued during the Weimar Republic after World War I, though by then it had lost influence due to economic loss and other structures of public welfare being established. In the context of the rise in eugenic and social darwinist tendencies during the 1920s, the implications of "racial hygiene" and hereditability came to be discussed among its members. After the takeover of the National Socialist Party in 1933, the "Hilfsverein" was forcibly assimilated into the Nazi welfare system and used to propagate racial ideology.

[Therapy of Food Refusal and Anorexia Nervosa in German-Language Psychiatry Textbooks of the Past 200 Years]. / Die Therapie der Nahrungsverweigerung und der Anorexia nervosa in deutschsprachigen Psychiatrie-Lehrbüchern der vergangenen 200 Jahre.

The aim of this study was to describe how the therapy of anorexia nervosa (AN) and food refusal have been discussed in leading textbooks used in German-speaking academic psychiatry over the past 200 years. For this purpose, 18 textbooks of important school psychiatrists were selected. These were analyzed in a structured way to determine the content of the subject taught at universities in German-speaking countries at a given period. We found that AN was not taught as a distinct disorder until the end of the 20th century, although great attention had been paid to food refusal as a symptom and manifold therapeutic concepts had been developed much earlier. Whereas at the beginning of the 19th century forced feeding using feeding tubes was established, in the following years pharmacotherapies and special diets were developed. It is noteworthy that since the beginnings of academic psychiatry, some early forms of psychotherapy have been developed; for instance, special kinds of behavior were recommended when dealing with the patient, as the therapist was supposed to serve as a role model to encourage patients to eat. Treatment of food refusal by means of structured psychotherapeutic approaches were not established before AN was generally accepted as a distinct disease entity. The understanding of etiological factors that might lead to AN as well as potential psychotherapeutic interventions have changed fundamentally over the past decades.

[The Practice of Medicinal Alcohol Withdrawal in the Psychiatry of the GDR - The Methods of Aversion and Disulfiram Treatment]. / Die Praxis der medikamentösen Alkoholentwöhnung in der Psychiatrie der DDR ­ Die Methoden der Aversions- und Disulfirambehandlung.

OBJECTIVE: The aversion and disulfiram treatment used for alcohol withdrawal in the GDR are described in their mode of action, application and in their therapeutic outcome. METHOD: In this literature study primarily works published in the GDR itself were identified, analysed and contextualised. RESULTS: While aversion therapy caused aversion to alcohol through the development of a conditioned reflex, disulfiram has an alcohol-sensitising effect. In therapeutic practice, the aversion therapy was largely replaced by disulfiram during the 1970 s, although there was no general guideline for its use. Disulfiram therapy could prove itself as a drug adjuvant, but was successively marginalised by psycho- and socio-therapeutic approaches. CONCLUSION: Both aversion and disulfiram therapy were the central drug procedures for the treatment of people with alcohol problems in the GDR psychiatric system, were applied inconsistently, and complemented a complex therapeutic regime.

[Adult attention deficit hyperactivity disorder (ADHD) in the clinical descriptions and classificatory reflections of Gustav Specht (1905) and Hermann Paul Nitsche (1910)]. / Die Aufmerksamkeitsdefizit­/Hyperaktivitätsstörung (ADHS) bei Erwachsenen in den klinischen Beschreibungen und klassifikatorischen Reflexionen von Gustav Specht (1905) und Hermann Paul Nitsche (1910).

The notion that the adult form of attention deficit hyperactivity disorder (ADHD) is not a construct of modern psychiatry is increasingly prevailing. Looking into the history of psychiatry can make an enlightening contribution here. Guided by this aim and specifically following literature referred to by Emil Kraepelin (1856-1926), we analyzed the content of one study each by Gustav Specht (1860-1940) and the later Nazi psychiatrist Hermann Paul Nitsche (1876-1948) from 1905 and 1910, respectively, on the topic of chronic mania. Our investigation concluded that in their case studies both authors described people who would today be diagnosed as suffering from adult ADHD as the clinical descriptions reveal core symptoms of this entity as defined by modern classifications. They also mentioned currently discussed research questions. Both authors expressed their dissatisfaction with the classificatory situation of these patients at the time. Specht even postulated a "completely independent mental illness" that he called "chronic mania", under which he classified all the patients suffering from today's adult ADHD. He also pointed out that this diagnosis was not widely recognized at the time by psychiatrists as a full-fledged form of illness but used more as a diagnosis to avoid the embarrassment of not having one. Nitsche saw the "chronic manic states" as he called them as a "clinical peculiarity" but assigned them to the large group of "manic depressive insanity", which could only be more finely differentiated in the future.

[The medical history of Elsa Asenijeff in the context of the Saxon psychiatric institution and care system from the 1920s to 1941]. / Die Krankengeschichte Elsa Asenijeffs im Kontext des sächsischen psychiatrischen Anstalts- und Versorgungssystems der 1920er-Jahre bis 1941.

AIM: This article aims to describe and discuss in detail the psychiatric medical history of the writer Elsa Asenijeff (1867-1941) in different mental institutions in the German state of Saxony. RESEARCH QUESTIONS: What can be discovered in preserved archive documents about the placement of Elsa Asenijeff in different mental institutions between 1923 and 1941? What is the historical context in which this individual medical history took place? MATERIAL AND METHODS: Through systematic research in different archives a part of Elsa Asenijeffs medical records and relevant administrative files of the institutions could be found. RESULTS: The preserved documents provide an insight into the statements of the physicians and the conditions of Elsa Asenijeffs placement in the institutions of that time. CONCLUSION: The findings of our research suggest that, at least since 1927, Elsa Asenijeff was kept in mental institutions primarly for being an unmarried, destitute and more or less isolated woman. In other words, her stay was justified with social and not psychiatric-medical arguments.

[Concepts of nymphomania in the German academic psychiatry: Changes over the last two centuries]. / Die Konzeptualisierung nymphomanischer Zustände in den Lehrbüchern der deutschsprachigen Schulpsychiatrie vom Beginn des 19. Jahrhunderts bis heute.

BACKGROUND: This chronology aims to provide an overview of the views on nymphomania in the history of German academic psychiatry over the past 200 years. AIM: The aim of this study was to answer the following questions: What are the continuities over that period with regard to the etiology, diagnosis, classification or therapeutic recommendations? What changes can be observed? Was the increase in sexual desire in women seen as a disease or rather as a symptom? What significance did psychiatry attribute to female sexuality at a certain point in time? What reasons can be identified for the perceptions made and conclusions drawn at a certain time? METHODS: A cursory review of the most influential German-language psychiatric textbooks of the respective period was conducted in chronological continuity. Relevant passages were identified, analyzed in detail and compared with each other, taking the historical context into account. RESULTS: At the turn of the 19th and 20th century, a clear break in the understanding of nymphomania as a disease could be observed. In the 19th century, it was seen as a severe mental illness, which was assumed to have been caused at least in part by a peripheral disease of the female reproductive organs and the nervous system associated with them, which could lead to irreversible terminal mental states. In the 20th and 21st centuries, nymphomania was perceived as either a sexual neurosis or a functional sexual disorder, limited to the symptom complex of hypersexuality. The reasons for this were, on the one hand, the overall change in diagnosis resulting from a comprehensive reclassification of mental disorders, which assigned nymphomaniac symptoms of the 19th century to both manic and schizophrenic disorders, and, on the other hand, changes in the perception of female sexuality in the social discourse in general. The fact that nymphomania as a diagnosis was eliminated with the 11th edition of the International Classification of Diseases is a clear expression of this change. CONCLUSION: The concept of nymphomania has undergone considerable changes over time. At the beginning of the 20th century, the understanding of the disease changed significantly, so that it is even possible to distinguish between an early and a late phase. The diagnosis has meanwhile become obsolete.

[The Psychotherapist and Neurologist Ernst Jolowicz (1882-1958): An International Career in the Shadow of Anti-semitism and Emigration]. / Der Psychotherapeut und Nervenarzt Ernst Jolowicz (1882­1958): Eine internationale Karriere im Schatten von Antisemitismus und Emigration.

The study focuses on the life and work of the German-Jewish neurologist Dr. Ernst Jolowicz who was born in 1882. Originally from Poznan in present-day Poland, Jolowicz had gained his initial professional experience in the German Empire before serving as a neurologist at the Western Front during the First World War. After the war, he opened a private psychotherapeutic practice in Leipzig, published numerous scientific papers and was involved in the General Medical Society for Psychotherapy. In his writings, Jolowicz appeared as an undogmatic adherent of suggestive techniques and came up with his own methods for a patient-centered, psychagogic psychotherapy. In addition, he wrote numerous cultural and social scientific essays showing a wide range of interest. Shortly after the seizure of power by the National Socialists, he emigrated to Paris and supported the anti-fascist resistance in a Strasbourg radio station. After the occupation of France, Jolowicz fled to the United States in 1941 and gained a foothold there once more before he died of a heart disease in New York City in 1958.

Electric neurostimulation in sleep disorders - yesterday and today. A comparative analysis of historical and contemporary case reports and clinical studies.

BACKGROUND: Insomnia is a widespread symptom of many psychiatric and neurological disorders, but can also be a clinically relevant disorder of its own. The application of low-dose electricity as a treatment for both has had a long history, dating back to the 19th century, but has seen somewhat of a renaissance in therapies such as tDCS. OBJECTIVE: The aim of this publication was to identify and present original works from the second half of the 19th century as well as contemporary studies that investigated the therapeutic value of electricity in treating sleep disorders. METHODS: While the nine historical sources identified mostly presented impressive successes in treatment, the nine modern publications had much more heterogeneous and moderate results. RESULTS: The discussion of these differences refers to the scientific discourse of the late 19th century about the placebo-effect and the role of suggestibility in the therapeutic process and outcome. CONCLUSION: In conclusion profound parallels can be seen between treatment innovations and methodological discussions in the 1880-1890s and nowadays.

[What Seems in Need of Psychiatric Care Does not Always Have to be. Hearing Loss as the Cause of a Suspected Psychopathological Diagnosis]. / Psychiatrisch Erscheinendes muss nicht immer psychiatrisch sein. Schwerhörigkeit als Ursache einer psychopathologischen Verdachtsdiagnose.

In the history of psychiatry and otology, there is evidence that mental and hearing disorders can be interdependent. For example, Emil Kraepelin in 1915 and a Leipzig serial study published in 1962 indicated that hearing-impaired people become psychologically conspicuous or mentally till more often than people whose hearing is not impaired.We outline the case of a patient who showed psychopathological abnormalities before and after giving birth to her daughter, especially in attention, cognitive conversion ability and social competence. After being diagnosed a bilateral moderate sensorineural hearing loss and being provided with hearing aids, no psychopathology was detectable. The case may be a pointer to the fact that hearing-impaired patients still fall through professional boundaries and are not provided with adequate care due to their lack of or limited ability to communicate.

The Work of Oskar Herzberg-Did Psychosis or the Residence in a Psychiatric Institution Serve as a Catalyst for Creativity?: A Thought-Provoking Impulse to Reconsider the Interrelationship Between Mental Illness and Art.

ABSTRACT: In the 1920s, the Heidelberg psychiatrist and art historian Hans Prinzhorn collected pictorial works by "mentally ill people"-today's Prinzhorn Collection.His colleague Paul Schilder sent him works by Oskar Herzberg thereto, which Prinzhorn included as "Case 355" in his famous work Bildnerei der Geisteskranken.Using Herzberg as an example, we approached the general issue of the relationship between mental illness, creativity, and art from a historical psychiatric perspective.It was not before his admission to the Leipzig clinic due to his schizophrenic illness that Herzberg began to paint. Prinzhorn and his doctor Ernst Jolowicz considered this late start of artistic activities to be the expression of an immanent creative urge caused by exceptional psychotic experiences. Our study intends to view such artworks outside a rather pathological context. Therefore, we discuss being secluded in psychiatry, supplied painting utensils, and released from his daily constrains as other possible triggering factors for Herzberg's artistic development.