[Society-research-diagnosis: have classification problems in psychiatry been overcome at the beginning of the new millennium?]. / Gesellschaft--Forschung--Diagnosen: Sind Klassifikationsprobleme in der Psychiatrie nach der Jahrtausendwende überwunden?

Although diagnostics of organic psychoses already had been quite well established at the beginning of the last century, no satisfactory results had been achieved in the field of functional psychoses. This led to a return towards the concept of "unitarian psychoses" and thus to a revival of cross-sectional diagnoses. With the development of psychopharmacological compounds the need for exact demarcation of disease grew. Around this time syndromatological classification systems that were supposed to be used internationally have been developed. In the course of the last thirty years the argument about the meaning of psychiatric diagnoses rose anew; the necessity of standardized means of psychiatric diagnoses was contrasted by the fact that there was no way of defining disease entities for clinical research. A polydiagnostic approach as well as clinical diagnose of the illness course--using single symptoms as predictors of the disease's course--could point to a solution.

[Is depression a women's disease?]. / Frauenkrankheit Depression?

The female preponderance in depression is one of the most robust findings in psychiatric epidemiology. The pertintent hypothesis of a possible role of biological and psychosocial factors and their relevance for the explanation of this gender gap are presented and discussed. Available data suggest that biological factors seem to exert an influence on the emergence of depression, but are unlikely to account for the gender differences in morbidity rates. Considering psychosocial factors like age, marital and employment status indicates that the claim that depression is more frequent in women is an oversimplification. There are groups were due to these variables no gender gap or even higher rates for males are observed.

Outpatient treatment of mentally disordered offenders in Austria.

The mental health system is faced with a growing number of MDOs with treatment orders. For more than 90% of our sample of 157 discharged irresponsible MDOs a mandatory outpatient treatment was ordered. Considering the fact that half of these patients are transferred after discharge to institutions like psychiatric hospitals or nursing homes (Leygraf, 1988), institutional as well as outpatient treatment options are needed (Silver & Tellefsen, 1991). Within the Austrian mental health system here is an enormous lack of post-discharge treatment facilities for forensic patients (Meise, Rossler, & Hinterhuber, 1994). Furthermore, the existing structures obviously do not meet the special needs of forensic patients. Although this point of view is shared by the psychiatric hospitals and their contentment with the settings for forensic outpatient treatment was low, only one hospital intended conceptional change and modifications. Facing the reality that the same psychiatric hospital authorities complained that they could not release MDOs from an inpatient status because of inappropriate outpatient facilities, the responsibility for forensic patients seems to be projected from the medical to the legal system. This can be seen as a symptom of the tendency to a step wise and long-standing exile of forensic patients from the mental health system. Actually, forensic patients were for various reasons refused by mental health professionals and could not get psychotherapy, medication or adequate psychosocial care. A possible answer to these problems is to establish institutionalized outpatient facilities in the "hybrid" gap between the legal and mental health system (Lamb, Weinberger, & Gross, 1988). The new outpatient clinic in Vienna deals with rejected treatment-order patients, most of them with additional treatment problems such as impulsivity, substance abuse, and mental impairment (Cote & Hodgins, 1990). The special structure of the institution (i.e., a multiprofessional team that offers a wide and easily accessible spectrum of interventions, the realization of individual treatment programs with psychotherapeutic and psychosocial as well as biological aspects, and the long-term personal continuity of care by staff members with forensic psychiatric skills) promoted the experience that after some time half of the patients came on a voluntary basis (Fenell, 1992; Winick, 1994). Some pressure by the court was an efficient way to guarantee regular treatment for patients with personality disorders and perversions. The model of a special, structured, multiprofessional outpatient clinic is successful, but the role of such complementary pilot institutions is ambiguous. Simultaneously, the deficit of adequate outpatient care for MDOs has to be opposed by stopping the unacceptable withdrawal of general psychiatry from the forensic sector.