Care of the insane in Lübeck during the 17th and 18th centuries.

Only selected aspects of the history of the House of the Poor Insane in the Hanseatic Free City of Lübeck have been studied to date.This article presents the results of an entire source study of this small institution in the 17th and 18th centuries, and briefly also during the next 40 years after the opening of a new building. In addition to the minute-book of the Governors, now kept in the Lübeck Municipal Archives, the results are based primarily on the account-books,which illustrate the institution's social history and activities. Examples are given. During most of the 17th century, the House was generally rather like a prison for the insane, but at the end of this century and in the early 18th there was a reform phase.This was followed by phases of repression and 'containment' at the end of the 18th century and in the early 19th century, before a renewed reform by the medical profession.The findings for Lübeck are compared with the development of inpatient care in institutions elsewhere, and the decisive factors in Lübeck are discussed.

The Upper Bavarian longitudinal community study on psychopathology 1975-2004: 1. Methods and first results.

OBJECTIVE: This paper presents background information on the methods and first results of the 25-years follow-up of the prospective longitudinal Upper Bavarian Study in the community. Longitudinal epidemiological studies which cover very long time spans require special methods. Issues concerning these requirements are discussed using design and experiences from the Upper Bavarian Study. METHOD: Assessments focused on three time points: baseline survey, five-year follow-up, and 25-year follow-up. Self-rating scales as well as expert-rating interviews yielded data on a wide range of social and psychopathological risk factors and outcome measures. RESULTS: Of the 1,342 study participants in the original sample, 390 had died during the 25-year follow-up period. Participation rate was 88% of those alive. At all three time points, a total of 838 participants were interviewed. Data on this unselected sample over a quarter century will be presented in forthcoming papers. Because of their mobility young individuals from our original sample were more difficult to follow up. We analyzed in detail data of subjects interviewed at t3 (and earlier time points) as compared to data from subjects not traced or reached, and subjects who refused to participate at wave t3. We found no evidence that the long-term outcome was biased by drop-out due to gender or earlier mental illness. CONCLUSION: Methodological possibilities and limitations concerning long-term epidemiological studies across decades are presented and discussed.

Self-rated general health and psychiatric disorders in a general population sample.

The purpose of this study was to explore the relationships between nicotine and alcohol dependence, depressive, anxiety and somatoform disorders with self-rated general health (GH). A cohort study of a random sample of the non-institutionalised general population aged 18-64 with a participation rate of 70.2% was carried out in a German area (n = 4075 at baseline). A follow-up of tobacco smokers or heavy drinkers (n = 1083, 79.4% of those who had given consent to be followed-up) was conducted 30 months after baseline measurement. The assessments included self-ratings of GH and Diagnostic and Statistical Manual (DSM-IV) diagnoses based on the Composite International Diagnostic Interview. The results show that nicotine dependence, anxiety disorders and somatoform disorders moderately predicted self-rated GH at follow-up (general linear model, R(2) = 0.12). We conclude that psychiatric disorders may contribute to the prediction of a low self-rated GH.

Specific somatoform disorder in the general population.

The authors assessed the validity of the recently proposed diagnosis for specific somatoform disorder in the general population. German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 individuals. Multivariate analyses were used to compare impairment, life satisfaction, and use of health care. A total of 803 of 4075 subjects (19.7%) with undifferentiated somatization disorder were identified, which included 51 subjects (1.3%) who met criteria for specific somatoform disorder. Subjects with specific somatoform disorder were more impaired, had lower life satisfaction, and had higher use of health care than subjects with undifferentiated somatization disorder only. The proposed diagnosis of specific somatoform disorder demonstrated a high validity independent of comorbid depressive and anxiety disorders.

Somatoform pain disorder in the general population.

BACKGROUND: Chronic pain disorder is assumed to represent a frequent and disabling condition. However, data on the prevalence of somatoform pain symptoms and somatoform pain disorder in the community are limited to date. METHODS: German versions of the Composite International Diagnostic Interview were administered to a representative national sample of 4,075 people. Somatoform pain disorder was diagnosed by standardized diagnostic algorithm based on the DSM-III-R criteria (absence of adequate physical findings). One subgroup was identified as also meeting the DSM-IV criterion B for 'significant distress or psychosocial impairment due to the somatoform pain'. RESULTS: A lifetime prevalence rate of somatoform pain disorder according to DSM-III-R of 33.7% and a 6-month rate of 17.3% was found. When applying the DSM-IV B criterion, the prevalence rate dropped to 12.3 and 5.4%, respectively. In both groups more than 95% of the probands had contacted their doctor because of the pain. In 25% of the probands the pain was positively assigned to psychological factors. A female:male ratio of 2:1 was found. CONCLUSIONS: Somatoform pain disorder (DSM-III-R) is a frequent condition. However, only about one third of these subjects is severely distressed or impaired by the pain. A clear operationalized concept of the DSM-IV criterion C 'psychological factors are judged to have an important role in the onset, severity, exacerbation or maintenance of the pain' should be provided in the further development of the diagnosis 'pain disorder' in order to make this diagnosis suitable for general population surveys.

Grupo de Trabajo de la OMS sobre "evaluación en Salud Mental": Reflexiones tras una experiencia de tres años

La Oficina Regional para Europa de la Organización Mundial de la Salud (OMS) en Copenague estableció un grupo de trabajo sobre evaluación en Salud Mental formado por expertos en Psiquiatría, los cuales, junto con los centros colaboradores de la OMS, prestan asistencia a una red Europea de Salud Mental constituido por 47 representantes nacionales para la Salud Mental nombrados por los diferentes ministerios. Este artículo discute las evaluaciones que se han hecho en siete estados de la Europa del Este y del Sureste durante los tres años de vida del grupo de trabajo. La mayoría de los instrumentos de evaluación que se utilizan en la actualidad exigen estudios de campo largos y costosos, que rara vez son posibles en el contexto de este tipo de evaluación. En el futuro se deberá hacer un esfuerzo considerable para consensuar procedimientos simples y fiables para evaluar estos parámetros y controlar la evolución. Por lo general, las evaluaciones descritas aumentaron el interés y la sensibilidad por las cuestiones de Salud mental, colocando de esta manera estas cuestiones en el centro de la política en la mayoría de los países concernidos (AU)