[Ethical case discussions before compulsory medication in psychiatry]. / Ethische Fallbesprechungen vor Zwangsmedikation in der Psychiatrie.

BACKGROUND: Ethical case discussions in psychiatric hospitals are particularly useful when a moral conflict between respect for the patient's autonomy and well-being becomes apparent when considering the legitimacy of coercive treatment. To date, there is hardly any data on the procedure and the results of such case discussions. We therefore present data from a large psychiatric clinic. AIM OF THE STUDY: We retrospectively analyzed ethical case discussions prior to compulsory medication in a quantitative and qualitative manner. METHODS: The study analyzed the protocols of all ethical case discussions over a 2-year period. They used the method of principle-based ethical case discussion. The qualitative analysis of selected cases was supplemented by reference to case records. RESULTS: An advance care directive was not available in any of the cases, so that the presumed will was used generally to assess the autonomy perspective. It proved quite complex to address danger to third parties when assessing the beneficence and nonmaleficence perspective. In 5 out of 35 consultations, the compulsory medication was not recommended from an ethical perspective. DISCUSSION: Ethical case discussions enable a holistic individual examination of moral obligations. They contribute to well-founded decisions and can help to reduce the frequency of coercive medications, suggesting routine use of ethics counselling.

Hoffmann's syndrome in the differential work-up of myopathic complaints: a case report.

BACKGROUND: Hoffmann's syndrome is a rare form of hypothyroid myopathy in adults, which is mainly characterized by muscular weakness and muscular pseudohypertrophy. CASE PRESENTATION: We report about a 61-year-old Western European man with myalgia, myxedema and pseudohypertrophy of the calf muscles. Laboratory tests revealed significantly elevated thyroid stimulating hormone (TSH) and creatine kinase (CK). Muscle MRI showed muscular hypertrophy of the lower limbs, but no signs of myositis or myopathy (no gadolinium enhancement, no edema, no fatty degeneration). In addition, electromyography (EMG) detected spontaneous activity. After the beginning of thyroxin-therapy it took six months until the muscle weakness improved and the myalgia regressed. CONCLUSIONS: Here, we focus on diagnostic routines and typical findings to differentiate Hoffmann's syndrome from other myopathies. Clinical hallmarks of Hoffmann's syndrome are pseudohypertrophy and weakness of the calf muscles in combination with elevated CK and elevated TSH. EMG is well suited to detect the involvement of the muscles and muscle MRI helps to differentiate it from other myopathies. Hoffmann's syndrome is a rare myopathy due to hypothyroidism and plays a role in the differential diagnosis of myopathic complaints even if hypothyroidism has not been detected before.