[Schizophrenia -- an existential disease]. / Die schizophrene Psychose als existenzielle Erkrankung.

This paper deals with familiar findings in the field of schizophrenic psychosis re-interpreted from a medical anthropological (V. Weizsäcker) as well as theoretical pathological (W. Dörr) view-point. Schizophrenic psychosis is thus discussed as an existential illness of the person as well as an aesthetic challenge for a certain cultural framework. This paper therefore investigates phenomenologically three main points that are not new but ought to be continuously re-considered: 1. The cultural-scientific thesis of a uniform onto- and pathogeny: Schizophrenic psychosis serves as topical example for the genetic and ontogenetic uniformity of so-called organic and psychic illnesses. 2. The anthropological thesis of the existential "Spiegelfunktion" of schizophrenic psychosis: From the phenomenological point of view, schizophrenic psychosis is defined as an existential illness hitting and reflecting the primary nature of human beings in a shocking way. 3. The therapeutic thesis of the effect and scientific basis of the paradoxical intervention: This thesis aims at describing the impossibility of understanding schizophrenic psychosis as a pathological but rather an anthropological phenomenon and problem of life, the acknowledgment of which shows therapeutic effect. The article's main concern is to discuss schizophrenic psychosis as phenomenon of existence and suffering, however not understandable, yet reflective of the existential predicament of humanity. This cultural-scientific concern is considered a permanent aim of subject-oriented medical analysis.

Understanding delay in treatment for first-episode psychosis.

BACKGROUND: A lengthy delay often occurs between the onset of symptoms of psychotic disorders and initiation of adequate treatment. In this paper we examine the extent to which this represents a delay in individuals contacting health professionals or a delay in receiving treatment once such contact is made. METHOD: Pathways to care were examined in 110 patients of the Prevention and Early Intervention Program for Psychosis in London, Canada. Data were collected using structured interviews with patients, family members, consultation with clinicians and review of case records. RESULTS: Family physicians and hospital emergency rooms were prominent components of pathways to care. Both delay to contact with a helping professional and delay from such contact to initiation of adequate treatment appear to be about equally important for the sample as a whole, but some individuals appear to be at risk for particularly lengthy delay in the second component. Individuals with younger age of onset, or who had initial contact with professional helpers before the onset of psychosis and were being seen on an ongoing basis at the time of onset of psychosis, had longer delays from first service contact after onset to initiation of adequate treatment. The greater delay to treatment for those being seen at the onset of psychosis does not appear to reflect differences in age, gender, symptoms, drug use or willingness to take medication. CONCLUSIONS: Interventions to reduce treatment delay should increase the public's awareness of the symptoms of psychotic illness and the need to seek treatment, but of equal importance is the education of service providers to recognize such illness and the potential benefits of earlier intervention.

Ultrasonographic evaluation of the cervix: transperineal versus endovaginal imaging.

OBJECTIVE: This study compares transperineal and endovaginal ultrasonography of the gravid cervix to evaluate image quality and assess for a systematic difference in cervical lengths measured by the 2 techniques. METHODS: Transperineal and endovaginal ultrasonography of the cervix was performed on 64 pregnant women. Two physicians reviewed the images and rated the relative diagnostic value of the techniques for assessing the cervix and for evaluating for placenta previa. Cervical length was measured prospectively in both techniques. Data were analyzed to determine if there is a systematic difference in length using the 2 approaches and if length differences are dependent on gestational age. RESULTS: There was a strong reviewer preference for endovaginal ultrasonographic images over transperineal images for both assessing the cervix (P< .001) and evaluating for placenta previa (P< .001). Despite this, transperineal and endovaginal ultrasonographic images were frequently rated as similar in diagnostic quality by both reviewers for depicting the cervix (35.9% of patients) and evaluating for placenta previa (57.8% of patients). The mean length of the cervix was slightly shorter at transperineal ultrasonography (28.4 mm) than at endovaginal ultrasonography (30.1 mm). When cervical lengths were subdivided by gestational age, however, a significant length discrepancy was found only in the 14- to 20-week gestational age range. In this age range, mean cervical length at transperineal ultrasonography (28.6 mm) averaged 5.5 mm less than at endovaginal ultrasonography (34.1 mm). CONCLUSIONS: Both transperineal and endovaginal ultrasonography can provide satisfactory images of the cervix, but endovaginal images are frequently superior to transperineal images. Endovaginal ultrasonography should be considered the optimal method for imaging the cervix in most situations. Transabdominal or transperineal ultrasonography can also be used, but if the cervix is not adequately depicted from these perspectives, endovaginal ultrasonography is indicated. Transperineal measurements of cervical length can be significantly shorter than endovaginal measurements, particularly before 20 weeks; therefore, short cervical lengths documented at transperineal ultrasonography before 20 weeks should be confirmed by endovaginal ultrasonography.

Laser treatment of orthodontically induced gingival hyperplasia.

Several studies have shown that gingivitis is common in children and adolescents. Introduction of orthodontic devices may exacerbate the gingival inflammation. Orthodontically induced gingival hyperplasia in adolescents, its etiology, and treatment alternatives are discussed. Three instances in which laser therapy was used are described.

Optimizing transperineal sonographic imaging of the cervix: the hip elevation technique.

Although transperineal ultrasonography is a valuable technique for imaging the cervix in pregnancy, transperineal imaging can be compromised when bowel gas obscures the external portion of the cervix. To determine if a hip elevation technique could improve visualization of a partially obscured cervix, transperineal scanning was performed with the hips and buttocks elevated on a thick cushion in 23 patients with suboptimal routine transperineal views. The "hips up" maneuver was tolerated by all patients and improved cervical visualization in 19 of 23 cases. We conclude that the simple maneuver of elevating the patient's hips and buttocks on a thick cushion is a useful adjunctive technique to improve transperineal imaging of the cervix when routine transperineal views are compromised by adjacent bowel gas.

AIDS and Austrian physicians.

Physicians have key roles both in treating disease and educating their patients about health and disease-related issues. To assess which factors correlate with Austrian physician's willingness to treat and educate patients about HIV-related risk behaviors and deal with AIDS issues, we conducted a survey of general practitioners, internists, and dermatologists in Graz, Austria. We report on some aspects of the knowledge, attitudes, and practices of these physicians. Factor analysis revealed two attitudinal components significantly associated with HIV-related practices of the respondents. We labeled these components Reluctance and Infection. "Reluctance" reflected discomfort with sex-related matters and was associated with less HIV counseling and less interest in HIV-related continuing medical education. "Infection" reflected a fear of contracting HIV disease and was positively associated with an increased assessment of different risk factors and a tendency to refer HIV-infected patients for all further treatment. Results suggest that physicians need further training in their ability to deal with HIV issues. Fortunately they seem willing to improve and take further training to do so. Patients, physicians, and the public would all benefit from acknowledging and dealing with the attitudes and needs of physicians toward HIV-related issues.

HLA haplotypes in children with adrenogenital syndrome and their parents.

HLA-A and B antigen typing was carried out by the standard NIH lymphocytotoxicity test in children with adrenogenital syndrome (AGS) from 11 families, further in 3 healthy siblings and 20 obligatory gene carrier parents. Of the children 7 had the salt-losing form. The AGS homozygote group was examined for the geno- and haplotypes of the HLA antigen and the heterozygote group for HLA antigen genotypes. Two AGS-affected children of the same family proved to be HLA-identical, while in other families the haplotypes of the healthy siblings were different from those of the affected children. As compared with the data of 222 healthy blood donors, the antigens of the HLA-A and B loci in the homo- and heterozygote groups showed no significant difference.