[Bremen Risk Assessment Scale for General Psychiatry. Predicting violent behavior in mentally ill patients discharged from general psychiatry]. / Bremen Risk Assessment Scale for General Psychiatry. Vorhersage fremdaggressiven Verhaltens psychisch Kranker bei Entlassung von allgemeinpsychiatrischen Stationen.

BACKGROUND: In order to identify psychiatric patients who have a higher risk of being aggressive towards others, a risk checklist, the "Bremen Risk Assessment Scale for General Psychiatry" (BRAS-GP) was developed. The results of the first trial are described in this article. METHODS: In this prospective study all in-patients who were treated in the last quarter of 2006 were included. The BRAS-GP was applied on discharge to patients who were treated involuntarily. In a 1-year follow-up all patients who had been readmitted were analyzed to assess if any aggressive incident had occurred to confirm or refute the prognoses. RESULTS: On evaluation of the readmissions data, we calculated sensitivity of 0.72 and specificity of 0.71 as well as an "area under the curve" of 0.74. Especially during the first months after discharge readmissions linked with aggressive behavior were observed. CONCLUSION: The BRAS-GP is a useful prognostic instrument with high predictive validity. It can be easily applied in general psychiatric wards to help identify risk patients. After detecting risk patients special treatment strategies can then be offered.

[Social history of open care of the mentally ill--from the municipal asylum to social psychiatric care]. / Zur Sozialgeschichte der "Offenen Irren-Fürsorge"--Vom Stadtasyl zum Sozialpsychiatrischen Dienst.

Outpatient psychiatric care linked to a hospital or institution is as old as psychiatry defining itself as a science. During the time of the Liberal Movement in Germany and the various revolutions that took place in several European countries (including Austria and various German states) in 1848, people were full of ideas and sociorevolutionary projects. It was then that they became conscious of the need to meet mentally ill persons in their own environment in order to help them in an adequate manner. Griesinger described in great detail such work as envisaged by him for his projected "municipal asylum" or "city asylum". However, all efforts in this direction were quashed in 1868 by a majority decision on the part of psychiatrics in favour of large-scale lunatic asyluma located far away from the densely populated areas. At the turn of the century, social awareness again began to grow; the asylums were overcrowded; and costs had risen tremendously. This resulted in building up a non-institutionalised "open service and care" for the insane. On the one hand, it was an outpatient care system in close co-operation with the asylum, i.e. the patients were looked up in their homes (Erlangen Model), whereas in several big cities the community Public Health Office was responsible for such psychiatric care (Gelsenkirchen Model). In the German Republic that existed from 1919 to 1933, "open" psychiatric care was extended, and the psychiatrist who advocated it were gradually drawn into a maelstrom of a sociodarwinistic type of racialism.(ABSTRACT TRUNCATED AT 250 WORDS)

[Balance of a therapeutic dwelling community -self-aid or care? (author's transl]. / Bilanz einer therapeutischen Wohngemeinschaft- Selbsthilfe oder Versorgung.

A therapeutic dwelling community (TDC) which has been in existence for more than 3 years, is described in respect to its history of origin and development outside existing psychiatric institutions or facilities. After having been confronted with the unsatisfactory follow-up care of a group of relatively young, in most cases only medium-term hospitalized schizophrenic patients, the initiators of TDC developed a concept which was destined to strike a balance between care and activation of self-aid within the TDC in order to promote the mental stability and autonomy of the former patients. A description is given of the tension arising from the concept, between the claims on the part of the residents for care to be given to them on the one hand, and the expectations on the part of the guiding personnel with regard to the self-aid potential of the inhabitants, the description being given for different levels. The structure, dynamics and results of group activities within the TDC are also described. In this connection, an attempt is made to show up the individual and group-referred limits of self-regulation of the inhabitants and of the therapeutic interventions; overstepping these limits endangers individual management of the TDC. An attempt is made to derive conclusions on the basis of the collected experience, which may be of importance for similar projects in respect of structure, financial jurisdiction, admission criteria etc.