Being a webcam.

Searching through studies of schizophrenic delusions with a view to the new media, we came across the case of a young woman who integrated the Internet in her delusional system. Analysing the story she told, we recognised a psychotic symptom, which we preliminarily called 'perception broadcast'. Perception broadcast shows a more complex structure than the related first rank symptom 'thought broadcast' described by Kurt Schneider. In our view the existence of a structure like perception broadcast depends on the existence of new technologies, such as the World Wide Web and 'virtual reality', creating new cultural patterns which themselves are associated with collective perceptions of derealisation.

St. John's wort (Hypericum perforatum)--is it safe during breastfeeding?

Both doctors and patients often treat postnatal depression with herbal preparations derived from St. John's wort. Because these preparations are available to patients as "natural" over-the-counter drugs for depression, they are popularly assumed to be safe. However, no systematic information exists regarding treatment of postnatal depression, infant's safety or pharmacokinetics of hypericum constituents in human breast milk or infant plasma. A mother with post-natal depression was admitted at our service. Her pharmacist had recommended taking a St. John's wort preparation three times a day (Jarsin 300, Lichtwer Pharma AG, Berlin, Germany). Four breast-milk samples (fore and hind milk) during an 18-hour period were analyzed to measure concentration of hypericin and hyperforin. Only hyperforin is excreted into breast milk at a low level, hyperforin and hypericin (two major active components) were below the lower limit of quantification (BLQ: below lower limit of quantification, LQ hypericin: 0.20 ng/ml, LQ hyperforin: 0.50 ng/ml) in this infant's plasma. No side effects were seen in the mother or infant. Before recommending St John's wort for the treatment of depression to women who breastfeed, long-term studies of outcome in infants are needed.

[Health care services for women with postpartum mental disorders--assessment of current options in Austria]. / Versorgungsstrukturen für Frauen mit postpartalen psychischen Störungen--Eine Bestandsaufnahme für Osterreich.

For many women childbirth is one of the most impressive life-events, but this period of life may also be a phase of increased vulnerability for psychiatric illness. 10-15% of women develop a postnatal depression (PND) after the birth of a child, and 1@1000 suffer from a puerperal psychosis. Despite the high prevalence, with estimates of approximately 10,000 women suffering annually from postnatal psychiatric disturbances in Austria, there has been a lack of medical attendance for these women and their children. Motivated by a research initiative from the EU on transcultural aspects of postnatal depression (PND) with 17 participating research centers world-wide, a research team at the Vienna University Clinic for Psychiatry initiated the investigation of conditions for mother-child-admissions at 31 psychiatric wards in Austria. These departments were asked about the possibility of conjoint mother-child-admission, and their experiences with this form of admission; 23 departments (74.2%) provided information. A total of 12 departments responded that they theoretically accepted mothers with their babies; however, they also indicated that until now these conjoint admissions had been performed only very rarely or not at all. Based on many years of experience in the field of postpartum mental health in Great Britain, British researchers have developed guidelines for need assessment and health care provision for women with postpartum psychiatric disorders. With the help of these guidelines, the Viennese team of psychiatrists tried to develop fundamental concepts for need assessment, diagnosis, and treatment of patients suffering from postpartum mental illness in Austria.

Delusions in first-admitted patients: gender, themes and diagnoses.

Whether there is a specific link between certain delusional symptoms and particular etiologies has not yet been completely clarified. In this study, 639 first ever admitted deluded patients were investigated in order to find out whether age and gender are associated with certain delusional contents, whether age at first admission may be linked to certain etiologies and whether it is possible to detect indicators particularly related to basic dysfunctions. At first admission, delusional female patients were older than men with a significant predomination of delusions of persecution, while men presented significantly more frequently delusions of jealousy and grandiosity. Within delusions of persecution, of religious or metaphysical content and of grandiosity, women were even significantly older than men. Religious or metaphysical and grandiosity contents occurred significantly more frequently in ICD-8 schizophrenia, indicating that these themes seem to be particularly linked to ICD-8 schizophrenia. Additionally, some target symptoms not included in the delusional symptomatology were investigated to test the relationship between delusions and schizophrenia. Overall, the results of the present investigation indicate that delusions are not specific for schizophrenia, and therefore, other symptomatological criteria should be applied for the nosographic attribution.

[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.

[Driver's license expertise and psychiatric diagnosis. An analysis of 712 specialist expert assessments]. / Führerscheingutachten und psychiatrische Diagnose. Eine Analyse von 712 fachärztlichen Gutachten.

In a large University Department of Psychiatry a retrospective analysis of 712 psychiatric expertises on fitness to drive was carried out to identify factors influencing the decision "unfit to drive". Psychological test results were identified as the most potent factors influencing this decision, whereas a psychiatric diagnosis seems to be less important. The results indicate that demographic data and history (previous psychiatric hospitalisations, previous verdict "unfit to drive") were not influential. It is concluded that today's psychiatrists, when carrying out expertises on the question of fitness to drive, do not follow previous recommendations of placing a verdict of "unfit to drive" on all persons with a psychiatric diagnosis. They obviously follow a more individualised and pragmatic approach.

Neuroaxonal dystrophy combined with diffuse Lewy body disease in a young adult.

A 30-year-old woman suffered from a progressive extrapyramidal syndrome, myoclonic jerks, spasticity, and organic brain syndrome; she was clinically suspected to suffer from Creutzfeldt-Jakob disease and died after 4 years of illness. At autopsy, widespread dystrophic axons and Lewy bodies (LBs) were found in her brain. Neuronal loss and diffuse reactive astrogliosis involved the gray matter including the cerebral cortex. Dystrophic axons occurred throughout the nervous system except for the cerebellar cortex and peripheral nerves. LBs involved the cerebral cortex as well as subcortical regions including amygdala and claustrum, brainstem including substantia nigra and locus coeruleus, and spinal cord. LBs were distributed extensively enough to be compatible with diffuse Lewy body disease (DLBD). Ubiquitin immunostaining labeled both dystrophic axons and LBs. The combination of neuroaxonal dystrophy and DLBD may result from cytoskeletal pathology which affects both neuronal cell bodies and axons with subsequent deficient proteolysis and ubiquitination.

[Stabilizing the social and health status of drug dependent patients with methadone. Long-term maintainance therapy--Vienna results]. / Soziale und gesundheitliche Stabilisierung Drogenabhängiger durch Methadon. Langzeitsubstitutionstherapie--Wiener Ergebnisse.

On September 25th, 1987 methadone was legalized in Austria for therapeutic use in drug addiction treatment in case of: 1. Long-term drug addiction with intravenous application of the drug, and several unsuccessful withdrawal therapies and/or 2. opiate addiction through intravenous application of the drug along with an existing HIV-1 infection. Since than, 291 patients were treated with methadone at the drug-dependency outpatient clinic of the Psychiatric Clinic of the University of Vienna. In 1990, 96 patients treated for more than one year were investigated using a standardized questionnaire. The image in which crime, prostitution, poverty, ill health all merge was broken by this decriminalization. Methadone treatment offers a first step toward social rehabilitation for drug addicts who have been living as criminals on the fringe of society.

[Nicotine--drug addiction--AIDS. Drug use habits of Vienna addicts]. / Nikotin--Drogensucht--AIDS. Drogengebrauchsgewohnheiten Wiener Süchtiger.

In Austria it is illegal to sell tobacco to young adolescents. A diverse sample of 358 narcotic addicts was investigated at the Psychiatric University Clinic of Vienna. Data were obtained from on site confidential interviews and a HIV-test was conducted. The individual drug use history was recorded and, interestingly, tobacco addiction was the first stage in starting a drug career. Furthermore, a strong correlation was observed between onset of heroin use and HIV-1 infection. It is concluded that in Austria not only the availability nicotine and alcohol to young adolescents should be prohibited, but also their use should be punishable. Easy access to nicotine as in public restaurants or from automatic distributors, has to be withdrawn. Tobacco advertisements may drive vulnerable young adolescents to early nicotine abuse and this may be followed by addition to other drugs and diseases causing death, including AIDS. Socioeconomic data, as well as the methadone data are presented. 180 out of the 358 patients were on methadone maintenance. Methadone treatment offers a first step toward social rehabilitation for drug addicts who have been living as criminals on the fringe of society. Physicians have a clear responsibility to lead the effort on all fronts against tobacco, especially in view of the HIV epidemic.

[Prevalence of HIV-1 infection in intravenous drug dependent patients 1986 to 1989 in Vienna]. / Prävalenz von HIV-1-Infektion bei intravenös Drogenabhängigen 1986 bis 1989 in Wien.

We report the results of a survey of a total of 553 intravenous drug users (IVDUs) investigated at the drug addiction out-patient unit of the Psychiatric Department of Vienna University for antibodies to human immunodeficiency virus (HIV-1) using both enzyme-linked immuno sorbent and Western blot assays. HIV-1 antibodies were found 1985/86 in 8.5%, 1986/87 in 14.5%, 1988 in 27.7% and 1989 in 29.7% of IVDUs. The introduction of methadone maintenance in 1987 attracted many IVDUs and increased the number of patients at the out-patient clinic. In 1989 more than 50% of the IVDUs are on methadone maintenance and already 84.5% of the HIV-1 infected drug users are treated with methadone.