Needs of forensic psychiatric patients with schizophrenia in five European countries.

AIMS: The purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff. METHODS: Patients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants' needs were assessed using the Camberwell Assessment of Needs-Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs. RESULTS: In this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS. CONCLUSIONS: Staff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients' self-assessments of needs yield important information for providing sufficient help and support.

[Advance directive of probands in pharmaceutical research : A medical ethics discussion]. / Probandenverfügung in der Arzneimittelforschung : Eine medizinethische Diskussion.

In the fourth Act on the amendment of pharmaceutical legal and other regulations in November 2016, the legislature has designated the proband advance directive based on the instrument of patient advance directive to enable group beneficial research with persons not capable of giving consent. This article describes the existing conditional need for group beneficial research and presents the problem of the decisive instrument for advance directives at the center of the considerations. The features of the proband advance directive concluded by the legislature stand in opposition to a successful implementation, particularly due to the necessary concrete clarification content far in advance for informed research participants. This article describes solution possiblities, which refer to the realization of the instrument of a proxy research authorization as well as the consideration of an advance research planning based on the advance care planning.

[On the road to psychiatric reform : Reconstructing the political preparation of the first Enquete Commission of the German Bundestag]. / Der Weg zur Psychiatrie-Enquete : Rekonstruktion der politischen Vorbereitung der ersten Enquetekommission des Deutschen Bundestags.

BACKGROUND: The purpose of this paper is to analyze the political preparation of the Enquete Commission of the German Bundestag which aimed at assessing and improving the psychiatric and psychotherapeutic/psychosomatic care in the Federal Republic of Germany. METHODS: We performed a selective literature review and a hermeneutic analysis of political, parliamentary and administrative records from public archives which reflect and help reconstruct the run-up process to the so-called Enquete of psychiatry. RESULTS: Literature and documents show how individual actors both in the mental health professions and politics bundled activities in the domains of psychiatry and mental health care as well as health/social politics; they helped to implement political, parliamentary and administrative steps leading up to the Enquete of the German Bundestag (1971-1975). In addition, the records and pertinent literature document the social, cultural and political developments in the Federal Republic of Germany which helped initiate the Enquete project. CONCLUSION: The Enquete was not a straightforward process and was also not tied to any moment. It fits more into the longer-term reform process of psychiatry in the Federal Republic of Germany.

[Confusion about P. Schröder, W. Villinger and H. Heinze : The three chairmen of the German Society for Child Psychiatry and Therapeutic Education between 1940 and 1945]. / Wirren um Paul Schröder, Werner Villinger und Hans Heinze : Die drei Vorsitzenden der Deutschen Gesellschaft für Kinderpsychiatrie und Heilpädagogik zwischen 1940 und 1945.

On 5 September 1940, the German Society for Child Psychiatry and Therapeutic Education (DGKH) was founded. In order to secure sustainable impact, the young professional association aimed to: (1) Increase its scientific reputation through the organization of regular conventions and publications, (2) Attain continuity in its leadership (board) and membership growth, and (3) Establish itself in national socialistic politics and society for health care policy matters. Due to the unexpected death of the first chairman, Paul Schröder, only nine months after DGKH's foundation, these objectives were seriously put into question. The search for a new chairman led to a struggle for power and direction involving rival medical and non-medical associations as well as governmental institutions. Rather contrary to current knowledge, newly discovered documents indicate that the DGKH definitely acted out and initially influenced healthcare policy both before and directly after Schroeder's death. To interpret the complexity of the succession decision process - which led to the more radical Hans Heinze being chosen over Werner Villinger - this study employs a qualitative historical network analysis approach. For the broader interpretation of results within the national socialistic healthcare context we refer to Lutz Raphael's concept of radical order theory.

[After the Action T4 : "Regionalized euthanasia" in the Günzburg Psychiatric Hospital]. / Nach der "Aktion T4" : "Regionalisierte Euthanasie" in der Heil- und Pflegeanstalt Günzburg.

BACKGROUND: In Bavarian psychiatric hospitals approximately 15,000 people with mental handicaps and mental illnesses were killed after the so-called Action T4. The Heil- und Pflegeanstalt (psychiatric hospital) Günzburg was a so-called Zwischenanstalt (interim institution). The aim of the study was to analyze its role in carrying out "regionalized euthanasia". METHODS: Based on defined criteria the patient records of deceased patients at the Günzburg Psychiatric Hospital between July 1941 and December 1943 were analyzed to establish whether criteria for "regionalized euthanasia" were fulfilled. RESULTS: During the study period 45 patients at the Günzburg Psychiatric Hospital probably died following actions by direct or indirect intention to kill using malnutrition, neglect, medication overdose or a combination of these actions. CONCLUSION: The Günzburg Psychiatric Hospital was involved in "regionalized euthanasia".

[German neurology and neurologists during the Third Reich: brain research and "euthanasia"]. / Neurologie und Neurologen in der NS-Zeit: Hirnforschung und "Euthanasie".

The connection between systematic killing of the mentally ill and disabled, euphemistically called "euthanasia" in the National Socialism ideology, and German brain research has been thoroughly investigated and in detail; however, the impact of this criminal nexus on the image and self-perception of German neurologists as well as the status of neurology as a medical discipline is still the subject of controversial debates.Between 1939 and 1945 the Kaiser Wilhelm Institute (KWI) in Berlin along with other research centres were insofar enmeshed in the "euthanasia" program as brains of killed patients were dissected in the guise of "concomitant research" in order to generate medical knowledge. Affected were mainly individuals suffering from oligophrenia, early childhood brain atrophy, cerebral palsy and epilepsy. According to current historical research, collegial networks were instrumental in receiving brains of killed patients. Furthermore, civil research units were supplemented by military ones at the KWI. These, too, were concerned with the collection of medical knowledge, for instance on injuries of the brain and spinal cord. The historical approach to consider the Nazi organizations and medicine as "resources for each other" seems, therefore, at least in part applicable to neurology.

[German neurology and neurologists during the Third Reich: Preconditions and general framework before and after 1933]. / Neurologie und Neurologen in der NS-Zeit: Voraussetzungen und Rahmenbedingungen vor und nach 1933.

This article focuses on the institutional development of neurology in Germany up to the rise to power of the National Socialists and the radical sociopolitical changes after 1933. A wide range of scattered secondary literature was assessed and evaluated. Additionally, some original sources are literally quoted and interpreted according to the context. Since the end of the nineteenth century a complicated process of separation from internal medicine and psychiatry led to the formation of a self-conscious discipline of neurology. The first generation of German neurologists succeeded in founding the German Journal for Neurology ("Deutsche Zeitschrift für Nervenheilkunde") in 1890 and their own neurological association, the Society of German Neurologists ("Gesellschaft Deutscher Nervenärzte", GDN) in 1907. On an international scale, however, the institutional implementation of neurology with only a small number of chairs and few neurology departments remained more than modest. The ambitions for autonomy ended 2 years after the change of power in 1933. Regulatory interventions by the government and psychiatric interests led to the fusion of the GDN with the psychiatric specialist society, the new association being called the Society of German Neurologists and Psychiatrists ("Gesellschaft Deutscher Neurologen und Psychiater", GDNP) in 1935. In this group psychiatrists dominated the discourse. The expulsion, imprisonment and murder of physicians declared as non-Aryan or Jewish along with the forced consolidation ("Gleichschaltung") at the universities prompted profound changes in medical and academic life. It remains an ongoing challenge of neurological historical research to measure the impact of this upheaval on the few neurology departments in hospitals and private practices.

[German neurology and neurologists during the Third Reich: exemplified by research on epilepsy]. / Neurologie und Neurologen in der NS-Zeit: Das Beispiel der Epilepsieforschung.

There are only a small number of studies dealing with the impact of eugenic theories and practices on the research of particular neurological diseases during the Third Reich. Thus, this contribution to the special issue on neurology in Germany between 1933 and 1945 focuses exemplarily on epilepsy research. By drawing on primary sources and secondary literature the article tries to reconstruct the scientific discourse of the time and consider the implications for patients. National socialistic ideology was based on eugenic thinking and the implementation of eugenic policies was a major political objective. An immediate effect of this policy was the passing of the Law for the Prevention of Genetically Diseased Offspring (Gesetz zur Verhütung erbkranken Nachwuchses) in 1933. According to this law "hereditary epilepsy" along with various other neurological and psychiatric disorders was regarded as a mandatory indication for forced sterilization. Subsequently, funding of epileptological research was generously increased and extended, e. g. at the German Research Institute (Deutsche Forschungsanstalt) in Munich and the Rheinische Provinzial-Institut in Bonn. The main focus was placed on idiopathic forms of the disease, which were a priori considered as hereditary. At the annual meetings of the Society of German Neurologists and Psychiatrists (Gesellschaft deutscher Neurologen und Psychiater), lectures and debates on epilepsy repeatedly constituted a key topic. Some participants opted for a broad interpretation of "endogeneity" and thus favored an extension of the practice of sterilization but others advocated a more differentiated and restricted attitude. Several neurology researchers showed a penchant for self-mobilization in line with the doctrine of the new government.

[German neurology and neurologists during the Third Reich: the aftermath]. / Neurologie und Neurologen in der NS-Zeit: Auswirkungen und Folgen von 1945 bis heute.

The article discusses the consequences for neurology as a discipline which resulted from neurologists' participation in the crimes committed under National Socialism (NS). Chronologically, the current literature distinguishes mainly four overlapping stages: (1) a first phase was characterized by legal persecution and "denazification", which was also the time of the Nuremberg doctors' trial in which no neurologists were on trial. A detailed documentation of the trial for the German medical profession was published by Alexander Mitscherlich. (2) In the subsequent practice of wide amnestying and reintegration of former Nazi followers during the 1950s, neurologists were no exception as its elite continued in their positions. The year 1953 was the year of the Lisbon scandal, when chiefly Dutch representatives protested against the participation of Julius Hallervorden in the International Congress of Neurology. The newly founded societies, the German Society for Neurology (Deutsche Gesellschaft für Neurologie, DGN) and the German Society for Psychiatry and Neurology (Deutsche Gesellschaft für Psychiatrie und Neurologie, DGPN), unanimously supported their member. (3) The next period was characterized by a nascent criticism of the prevailing attitude of covering up the crimes committed by physicians during the Nazi period. The discovery of incriminating brain sections at various Max Planck Institutes brought neurology to the focus of the debate. (4) Since the 1980s and 1990s historians (of medicine) have been systematically examining medicine's Nazi past in a professional way, which resulted in a noticeable increase of knowledge. Additionally, a new generation of scholars provoked a change of mind insofar as they recognized medicine's responsibility for the crimes committed between 1933 and 1945. We expect that future historical research will further elucidate the history of neurology during the NS regime and have consequences for our current understanding of research ethics.

[Non-directivity as a guiding category in human genetic counselling in a historical perspective]. / Nicht-Direktivität als Leitkategorie in der humangenetischen Beratung in zeithistorischer Betrachtung.

In this article we describe and analyse the issue of non-directivity in human genetic counselling in Germany between 1970 and 2010 based on printed sources and oral history interviews. The focus is on the extent to which the ethical aspects in genetic counselling were debated among human geneticists and to what extent aspects of non-directivity were discussed.As the results show, it was not only in retrospect that experts attributed great importance to the autonomy of those seeking advice and rejected "directive" advice, at least in public positions. They considered ethical justification to be central here.

[From "schizophrenia" to "disturbance of the integrity of the self": causes and consequences of renaming schizophrenia in Japan in 2002]. / Von der "Schizophrenie" zur "Störung der Einheit des Selbst" : Ursachen und Folgen der Umbenennung der Schizophrenie in Japan im Jahre 2002.

In August 2002 the Japanese Society of Psychiatry and Neurology decided to rename the Japanese expression for schizophrenia from Sêshin Bunretsu Byô to Tôgô Shicchô Shô. Currently the psychiatric classification systems ICD-10 and DSM-IV are under revision. Against this background the Japanese process of renaming a psychiatric disorder is of high interest as far as the clinical, social and cultural implications of the new name are concerned.The authors give an overview of the Japanese process of renaming schizophrenia. Its background and realization are explained and the expectations of Japanese physicians, patients and their families related to the new name are analysed. Furthermore, its effects are evaluated. The aim of the paper is to clarify in how far the Japanese example may serve as a model for evaluating the possible implications that a renaming or nosological redefinition of schizophrenia might have in the course of the revision process of ICD 10 and DSM IV.

[Oral history of German human genetics: historical research methods for collecting and processing narrative interviews]. / Oral-History-Projekt Humangenetik: Historische Forschungsmethode zur Erhebung und Weiterverarbeitung narrativer Interviews.

Between 2016 and 2018, interviews with 33 persons were conducted about the history of human genetics in Germany between 1970 and the 2000s. 29 interviewees gave consent to have the interviews used for historical research. These interviews are currently being analysed with the methods of qualitative content analysis and grounded theory. The focus of this article lies on the critical examination of the method of oral history and its application to human genetics. The oral history project focuses on questions regarding (1) biographical data and careers of interviewees, (2) development and application of diagnostic and therapeutic techniques, (3) establishment and growth of institutions of human genetics and (4) social debates regarding the discipline.

[Historical awareness and historical responsibility in German human genetics]. / Geschichtsbewusstsein und historische Verantwortung in der deutschen Humangenetik.

Historians have repeatedly pointed to personal and institutional continuities between eugenics in Germany before 1945 and the developing human genetics in post-war Germany. But how was this external perception discussed among German human geneticists and did it play a role in the discipline's self-image? On the basis of printed sources and biographical interviews, the historical consciousness and the assumption of historical responsibility among German human geneticists active in the field between the 1970s and the 2010s were investigated. In the memories of the contemporary witnesses, historical awareness played a role for their discipline even before the 1980s, and since the founding of the Deutsche Gesellschaft für Humangenetik in 1987, the question of the form of showing historical responsibility has been discussed repeatedly. It has been expressed, for example, in discussions with the public and renaming of prizes.

[Urology goes electric-electrotherapy : Modern therapies in the treatment of modern diseases-examples from urology]. / Die Urologie wird elektrisch ­ Elektrotherapie : Moderne Therapien zur Behandlung moderner Erkrankungen ­ Beispiele aus der Urologie.

The significance of electricity for medicine in the modern industrial age should not be underestimated. Particularly in connection with neurasthenia, electrotherapeutic approaches also experienced a boom for domestic use. Thus, electrotherapy reached urology just as it was becoming established as a medical specialty. We analyzed urological manuals and textbooks and objects in the W. P. Didusch Center for Urologic History and the Museum zur Geschichte der Urologie in Berlin to present the wide range of indications for electrotherapy in the emerging field of urology from impotence to urethral strictures and try to highlight the variability of their importance over time.

[Technization of the senses--from uroscopy to urinalysis. The example of urine sugar]. / Technisierung der Sinne--von der Harnschau zur Urinanalyse. Das Beispiel der Harnzuckerbestimmung.

Since antiquity, medical semiotics has been based on signs solely accessible to the physician's sensory perception. In the 19th century, the spectrum of signs was extended by using new techniques and instruments, as well as chemical analytical procedures. Transferring technoscientific methods to the medical area led to a paradigm shift: Qualitative signs, which had been adequate for "humoral pathology", were by no means sufficient for epistemological investigations based on quantifiable data.This paper examines this process of "technization", using the example of measuring sugar in patients' urine. We reconstruct the evolution of technical methods for analyzing urine during the 18th and 19th centuries and show that traditionally oriented physicians and many patients showed a lack of understanding or even disapproval of the new "iatrotechnic" methods. Only very slowly were they willing and able to adjust to a semiotic turn, i.e., the increasing replacement of linguistic signs by abstract data.It is argued that only a complex of compromises--incorporating transdisciplinary receptiveness, professional isolation, economic viability, and sufficient accuracy, handiness, and manageability of instruments--gave rise to the broad acceptance of technical means to measure the amount of sugar in urine.

["Psychosurgery" and deep brain stimulation with psychiatric indication. Current and historical aspects]. / "Psychochirurgie" und tiefe Hirnstimulation mit psychiatrischer Indikation. Aktuelle und historische Aspekte.

Deep brain stimulation is a novel and reversible surgical intervention in the treatment of psychiatric disorders. Recent studies in small samples of patients with depression and obsessive-compulsive disorder have come up with promising results. Neurosurgical interventions in psychiatric patients raise ethical questions in the context of historical experiences with traditional and irreversible psychosurgical procedures that need to be discussed.

Historical review: a short history of German neurology - from its origins to the 1940s.

This paper aims at reconstructing the development and role of German neurology between 1840 and 1940. Therefore a couple of original sources as well as selected material form the scattered secondary literature were assessed and reviewed. Since the middle of the nineteenth century, an intricate process of separation from internal medicine and psychiatry gradually led to forming a self-conscious community of German neurologists. While Moritz Heinrich Romberg had constructed a cognitive basis for neurology, scientific founders such as Wilhelm Erb, Carl Wernicke, Alois Alzheimer, Hermann Oppenheim, Max Nonne, and many others established the new discipline within modern medicine. In 1891, the first generation of "pure" neurologists succeeded in founding the German Journal for Neurology (Deutsche Zeitschrift für Nervenheilkunde) followed by an autonomous professional organisation, the Society of German Neurologists (Gesellschaft Deutscher Nervenärzte) in 1907. A variety of external factors, however, hampered the institutional evolution and thus the implementation of chairs and departments remained quite modest. In 1935, only 2 years after the National Socialists had seized power, the regulatory merger with the psychiatrists' society caused the cautious attempts of German neurologists for autonomy to end in complete failure. The imprisonment, murder and expulsion of neuroscientists declared as Jewish or non-Aryan caused profound changes in neurology, medicine, academic life, and health care in general. Further historical research is needed to reconstruct in detail the involvement of German neurologists in racial-hygienic and eugenic research as well as the institutional and scientific development of German neurology after World War II.

Targeting ethical considerations tied to image-based mobile health diagnostic support specific to clinicians in low-resource settings: the Brocher proposition.

Background: mHealth applications assist workflow, help move towards equitable access to care, and facilitate care delivery. They have great potential to impact care in low-resource countries, but have significant ethical concerns pertaining to patient autonomy, safety, and justice. Objective: To achieve consensus among stakeholders on how to address concerns pertaining to autonomy, safety, and justice among mHealth developers and users in low-resource settings, in particular for the application of image-based consultation for diagnostic support. Methods: A consensus approach was taken during a three-day workshop using a purposive sample of global mHealth stakeholders (n = 27) professionally and geographically spread. Throughout a series of introductory talks, group brainstorming, plenary reviews, and synthesis by the moderators, lists of actions were generated that address the concerns engendered by mHealth applications on autonomy, justice and safety, taking into account the development, implementation, and scale-up phases of an mHealth application lifecycle. Results: Several types of actions were recommended; key ones among them included building in risk mitigation measures from the development stage, establishing inclusive consultation processes, using open sources platform whenever possible, training all clinical users, and bearing in mind that the gold standard of care is face-to-face consultation with the patient. Recommendations of patient, community and health system participation and of governance were identified as cutting across the mHealth lifecycle. Conclusion: Priorities agreed-upon at the meeting echo those put forward concerning other domains and locations of application of mHealth. Those more forcefully articulated are the need to adopt and maintain participatory processes as well as promoting self-governance. They are expected to cut across the mHealth lifecycle and are prerequisites to the safeguard of autonomy, safety and justice.

40th birthday of the Italian Mental Health Law 180 - perception and reputation abroad, and a personal suggestion.

How things are perceived from a distance may help better understand their nature. Perceptions at home are likely to shape perceptions abroad. The mutual cross-references between local and distant perspectives on the Italian Mental Health Law 180 may help understand the process which preceded and resulted in the reform. This editorial argues that Law 180 came about at a unique - enabling - time in history. It argues that the run-up to and passing of Law 180 constituted a great accomplishment by professionals, the wider public and politicians/administrators. This editorial goes on to argue that the profession managed to cope with (many) adverse effects of the reform. The attention that Law 180 has received internationally should be devoted to other national (or regional) mental health reform processes as this may help us to understand how mental health care systems evolve and what defines 'windows of (operative) opportunity' or 'moments for (public) action'.