ABSTRACT
People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.
Subject(s)
Commitment of Mentally Ill/legislation & jurisprudence , Commitment of Mentally Ill/standards , Interdisciplinary Communication , Intersectoral Collaboration , Mental Disorders/rehabilitation , National Health Programs/legislation & jurisprudence , Substance-Related Disorders/rehabilitation , Ambulatory Care/ethics , Ambulatory Care/legislation & jurisprudence , Ambulatory Care/standards , Commitment of Mentally Ill/ethics , Ethics, Medical , Expert Testimony/ethics , Expert Testimony/legislation & jurisprudence , Germany , Humans , National Health Programs/ethics , Patient Admission/legislation & jurisprudence , Patient Admission/standards , Prisoners/legislation & jurisprudence , Prisoners/psychology , PrognosisABSTRACT
This case report concerns two schizophrenic patients with "psychogenic" polydipsia, without any underlying somatic disease. Although case A showed a correlation between excessive water intake and severity of psychomotor disturbance, this could not be safely diagnosed as a water intoxication because the sodium serum level was normal. The lowered sodium serum level in case B, however, allowed us to conclude that the manifestation of grand mal was a sign of a genuine water intoxication. 27 casuistic studies on 67 patients with the syndrome of self-induced water intoxication in schizophrenics are then reviewed. Finally, a variety of diagnostic and pathogenetic problems of this syndrome is discussed, with special reference to the role of inadequate ADH secretion.
Subject(s)
Schizophrenic Psychology , Water Intoxication/psychology , Adult , Aggression/psychology , Drinking , Hallucinations/psychology , Homicide , Humans , Male , Middle Aged , Suicide, Attempted/psychologyABSTRACT
In 62 out-patients under maintenance treatment with lithium, thyroid function was evaluated. 21% of the patients exhibited goiter II0; 34% showed elevated thyrotrophin (TSH) serum levels; in 42% exaggerated TSH response to intravenous thyrotrophin releasing hormone (TRH) was found.
Subject(s)
Lithium/adverse effects , Thyroid Gland/drug effects , Adult , Clinical Trials as Topic , Depression/drug therapy , Female , Humans , Lithium/therapeutic use , Male , Middle Aged , Thyroid Function Tests , Thyrotropin/blood , Thyrotropin-Releasing Hormone/blood , Time FactorsABSTRACT
The use of guanidine hydrochloride is reported in the treatment of 4 cases of Werdnig-Hoffmann disease. Improvement was achieved in two cases. Amelioration was initially observed in the third patient, but a relapse occurred during temporary discontinuation of therapy and the disease progressed, albeit at a slower rate, after resumption of therapy. The final case was a terminal one in which, however, slight temporary improvement occurred in response to therapy. A maximum dosage of 0.4 g (based on the assumption of an average body weight of 15 kg in these children) was reached by gradual increments. Side effects like shortlasting vomiting were observed only in case 1. The pharmacological action of guanidine hydrochloride is discussed. According to Otsuka and Endon the mechanism of action may be based on an increase in the end-plate potential amplitude. However, an augmented supply of spinal transmitters may also play a role in the mediation to the pharmacological action.
