[German-speaking memory clinics: state of the art and practical recommendations]. / Erkennung und Behandlung der Demenz in den deutschsprachigen Memory-Kliniken: Empfehlungen für die Praxis.

The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

[Reality of geriatric psychiatry services in a large West German city]. / Die gerontopsychiatrische Versorgungsrealität in einer westdeutschen Grossstadt.

A comprehensive survey of psychogeriatric services was carried out as a part of public health planning in Solingen, a city of 165,000 inhabitants. The investigations consisted of extensive questionnaires and numerous interviews. Mental disorders are suspected in 15-20% of general practitioner's patients, in 62% of community health care center clients and in 65.5% of the residents of geriatric nursing homes and old people's homes. Hardly half of the latter and less than 20% of the clients of community health care center are under psychiatric treatment. Psychiatrists reach only about half as many elderly persons as must be expected from epidemiological data; the rate of clinical psychogeriatric treatment is lower than in some other German regions. The extend of psychotherapy in old age is very low. Collaboration between general practitioners and psychiatrists should be improved; in institutions training and supervision are deficient.

[Depression and benzodiazepine dependence in the elderly. On the complexity of psychiatric manifestations and psychiatric treatment]. / Depression und Benzodiazepinabhängigkeit im Alter. Zur Komplexität von psychiatrischen Krankheitsbildern und von psychiatrischen Behandlungen.

The example of a 70 year old female patient with endogenous depression and benzodiazepine dependency at the same time shows the problems created by the attempt to attribute the clinical picture to only one singular cause. As in the beginning we were not aware of her benzodiazepine dependency, she underwent withdrawal, so that the clinical picture became very complex and lengthy; it should be considered that long-term benzodiazepine use as well as withdrawal might have contributed to genesis, at least to manifestation of the depressive disorder. Apart from the self-contained depressive disorder and benzodiazepine dependency, obviously biographic-psychodynamic and family-dynamic factors have been important in formation, but as well in remittence of the complex clinical picture. An impressive urinary retention without detectable organic origin which persisted for several weeks is remarkable.