[Max Scheler and Kurt Schneider. Scientific influence and personal relationship]. / Max Scheler und Kurt Schneider. Wissenschaftlicher Einfluss und persönliche Begegnung.

Two years after Kurt Schneider had finalised his thesis qualifying him as a lecturer at Cologne University, he completed his doctorate dissertation in philosophy, also at Cologne University. His advisor was Max Scheler. Schneider published the results of his researches in a short monograph. It appears that at this time Scheler's phenomenology began to influence psychiatry. However, Kurt Schneider made only passing references to Max Scheler in this regard. Nevertheless, Scheler's influence on Schneider remained noticeable even in his most famous book "Clinical Psychopathology". Years after their academic contacts, Scheler, on several occasions, asked Schneider's advice concerning his psychically disturbed son Wolfgang. Schneider's diagnosis amounted to a case of a severely psychopathic personality. He informed Max Scheler on this and, subsequently, Wolfgang Scheler was interdicted, i.e. legally incapacitated.

Carl Wernicke and the concept of 'elementary symptom'.

Examination of contemporary medical conference papers reveal that the German clinician, Carl Wernicke, conducted a unique on-going inquiry into psychiatric nosology. Wernicke was searching for what he called the elementary symptoms of mental disorder, or, in other words, the single psychopathological feature, from which all others arose. From 1892 onwards, he postulated a variety of such elementary symptoms. Wernicke's theory makes sense in terms of such categories as anxiety-psychosis and hallucinosis. His work contrasts with that of Kraepelin and also with modern diagnostic criteria. Neither Wernicke nor his followers pursued the theory of elementary symptoms, but an examination of his work sheds light on modern ideas about diagnosis.

[Is drug dependence an occupational risk for physicians?]. / Abhängigkeit für Arzte ein Berufsrisiko?

Physicians are probably a high-risk group for the development of dependency. In addition to the particular demands associated with the profession of medicine, another cause is to be sought in the specific aspects of a doctor's personality. Occupational stress and an inability to develop adequate compensatory mechanisms can lead to burnout and addiction. Over and beyond treatment, rational prophylaxis is urgently required, and this should not fail to include a critical consideration of the self-image of the medical profession.

[Physicians as patients--on the problem of the mentally ill physician]. / Arzte als Patienten--zur Problematik des psychisch kranken Arztes.

The phenomenon of mentally ill physicians is hardly noticed in Germany today-a fact that possibly indicates a taboo. This investigation is to reveal the importance of the subject by referring to the findings of several major studies. Epidemiological data turn out to be of little reliability regarding for instance the number of impaired physicians with a range between 0.5-46%. Addiction and substance abuse can be found in 90% of all cases of mental illness. Increased suicide (3-4x), divorce (20x) and addiction rates (according to some authors 30-100x) in comparison with the average population emphasise the necessity of further investigation. These facts imply the question whether doctors are mentally more vulnerable than their patients. Special difficulties in treating doctor-patients deserve attention as only little is known how appropriate "iatrotropic" (psycho-)therapy can be carried out effectively.

[Drug dependence among physicians]. / Suchtverhalten bei Arzten.

Physicians are at higher risk of addiction compared with the general population. Worldwide about 15% of physicians may be addicted to drugs or alcohol. In Germany, accurate epidemiological data are not available. The underlying issues of this occupational risk are the dangers of "role strain", features of a "typical" personality and a high rate of burnout among physicians. Most important is therefore prevention, the need to persuade physicians to "cherish themselves" and reduce work stress as far as possible. An US-program is described regarding identification and therapy of drug users among physicians.

[Psychoses in multiple sclerosis--a reevaluation]. / Psychosen bei multipler Sklerose--eine Neubewertung.

With the aim of reaching a new classification of psychoses with multiple sclerosis we reviewed the twentieth century literature for observations with regard to the subject, as well as 688 medical records of our patients, looking for the occurrence of paranoid and hallucinatory psychoses in the course of multiple sclerosis. Special attention was paid to the occurrence of cycloid psychoses. With multiple sclerosis, psychoses on the whole--but cycloid psychoses in particular--occur more frequently than in the general population. Women are affected just as frequently as men. Cycloid psychoses occur earlier in the course of the multiple sclerosis than the other psychoses; here, hallucinations occur with a higher frequency. Similar as in the case of HIV-infection, multiple sclerosis can act as a trigger of a cycloid psychosis. The results of our study indicate that men and women experience this disease as similarly threatening. A shortcoming of critical faculties based on the organic disease is an additional factor that favours the outbreak of such a psychosis.

The origin of the concept of paranoia.

The concept of paranoia has developed virtually simultaneously in Germany and France at the beginning of the nineteenth century. Originally, the idea of a disease of only a part of the soul was in the foreground of discussions. At the era of positivism and the belief of psychiatric illnesses purely as consequences of organic disorders, the concept changed to psychopathologic findings. Now delusions and particularly their systematic character were emphasized. Moreover, the absent impairment of "mental life in its entirety" was given prominence. At the beginning of the twentieth century, the arising concept of schizophrenia thrusts the discussion of paranoia into the background. It was not possible to find out which parts of paranoia were absorbed by dementia praecox. Finally, the development of modern diagnostic manuals revived the old clinical picture mainly because of its clinical evidence and the distinction from schizophrenia.

[Site-dependent psychopathologic symptoms in brain tumors exemplified by olfactory meningioma]. / Lokalisationsbezogene psychopathologische Symptome bei Hirntumoren am Beispiel der Olfaktoriusmeningeome.

Despite the propagation of imaging techniques in recent years, brain neoplasms are still identified too late in many cases, not least because of a disregard or misinterpretation of early psychiatric symptoms. By means of a detailed report of a case of olfactorius meningioma, together with a summary of 13 other cases from the same hospital over the past 15 years, it is demonstrated that a specious psychodynamic "understanding" may delay the correct diagnosis. Possible reasons for the initial false diagnosis are considered in detail.

Inpatient treatment of conversion disorder: a clinical investigation of outcome.

In a retrospective survey, a group of 220 patients with conversion symptoms was subdivided according to clinical findings at the time of discharge. The longer the duration of the symptom and the older the patient, the less was the beneficial effect of treatment. One particular problem with therapy for conversion symptoms lies in the fact that, in his own eyes, the patient is not psychologically ill, but physically ill. Time and again, it proved a therapeutic blind alley to try and convince the patient that the cause of his conversion symptoms was 'purely psychological'. Special guidelines for therapy of conversion symptoms are derived.

[Immunoglobulin G synthesizing lymphocytes in the cerebrospinal fluid in multiple sclerosis and non-inflammatory diseases of the nervous system]. / Immunglobulin G synthetisierende Lymphocyten im Liquor bei Multipler Sklerose und nichtentzündlichen Erkrankungen des Nervensystems.

In 208 patients, the IgG-synthesizing lymphocytes of the CSF were demonstrated with immunocytochemical methods. These cells were found in 59 of 111 patients with multiple sclerosis. Their frequency of appearance was dependent on the duration of the disease and its clinical severity. A comparative laser-nephelometric examination of serum and CSF, together with CSF cell diagnosis, demonstrated that IgG-synthesizing lymphocytes were present in 12% of the patients without simultaneous local IgG production within the CNS. These cases showed mostly very short clinical courses. IgG-synthesizing lymphocytes were absent from the CSF of 97 patients with non-inflammatory diseases of the nervous system.

OKT8-binding lymphocytes in diseases of the nervous system.

OKT8-binding lymphocytes, which consist mainly of suppressor-cytotoxic T cells, were demonstrated in blood and CSF by an immunochemical method. In patients with non-inflammatory diseases, the mean value was 18% in blood and 19% in CSF. In acute viral infections of the CNS, on the other hand, the percentage was significantly lower in the initial days of the disease but then increased up to the 5th week. Eleven patients suffering from multiple sclerosis had similar percentages of OKT8-binding cells, whether or not they had acute symptoms.