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Biomedical subjects

C Scharfetter

Publications and source records attributed to C Scharfetter.

At least 19 recordsLinked to original sources

[Responsibility and guilt from the psychiatric/psychotherapeutic viewpoint].

The sense of universal responsibility of the individual is based on a religious (in a pre- and overconfessional sense) relationship to a transpersonal whole. It is a prerequisite for the philosophical discourse on ethics. The special responsibility of the psychiatrist in his anthropological constructs, his concepts of illness and disease, and his method of treatment are discussed. The patient's being responsible (at least partly) for falling ill, his coping with his disease and impairment, his cooperation during treatment and also the pathology of inadequate guilt feelings and deficits are dealt with. Taking the blame as part of the human condition may be seen as an indicator of a mature development of a person.

Defense Mechanisms

On the prognostic relevance of ego-psychopathology in schizophrenia: a 2.5-year follow-up.

Based on a calibration sample comprising 552 schizophrenic patients, ego-psychopathology was modelled in terms of three empirical scales. For this purpose, a special assessment instrument (EPIS) had been designed which measures the phenomena of self-experience in psychotic individuals. Within the scope of these investigations, a 2.5-year follow-up study was carried out with 85 schizophrenic patients. The principal goal of this study was to test the predictive power of typical patterns of self-experience with respect to social functioning. In order to analyse the homogeneity of the data multidimensional scaling and cluster analysis was employed. The results derived from the initial interview suggested a partitioning of the population into two extreme groups termed, according to our model, high-risk and low-risk cases. The predictive power of ego-psychopathology with regard to the social situation was then tested by comparing the outcome of both groups after 2.5 years. The analyses yielded no indication that there is a strong relationship between ego-psychopathology and social adaptation. Only a tendency could be found suggesting that subjects with few ego-psychopathological disturbances have a better occupational behaviour.

Adaptation, Psychological

[Suicide of schizophrenic patients].

The suicide-mortality of schizophrenics is between 1-5% (max. 10%) according to the literature and own studies. Suicide may take place during the whole course of the disorder. It happens mainly outside the hospital. Most of the suicidal schizophrenics are depressed, suffer from resignation, deny their illness and are noncooperative in treatment programs. Male patients of medium age, severely disturbed premorbid personality and hostile split family atmosphere are further criteria of increased suicide danger.

Cross-Sectional Studies

[The shaman: witness of an old culture--is it revivable?].

The shaman concentrates a multitude of functions in the presecularized culture. In it disease is, as any experience of reality, hierophania, manifestation of transcendence. The shaman is a specialist in producing and managing altered states of consciousness. The constitutive criteria of shamanism are discussed. In the social network the shaman is a central and marginal "gestalt" at the same time, ambivalent for his community. In the postshamanic culture derivatives of shamanism and non-inspirational healers (naturalists) are active. Corresponding to the mystic concept of illness the various healing techniques of the shaman are intended to reestablish a harmonized cooperation with transintelligible powers. The therapeutic efficacy appears unsatisfactory inasfar severe somatic or psychic disorders are concerned. Empirical medicine still lacks a culturadequate holistic concept of illness offering a basis for sufficient treatment of psychosocially determined disorders.

Consciousness

[Psychopathology and genetics of schizophrenia].

The history of psychopathology of schizophrenia from Kahlbaum to Kraepelin is reviewed: Bleulers concept of symptoms and his construct of primary disorder. Today symptomatology and syndrom - construction by modern techniques of evaluation are prominent aims of research. The ego-psychopathology is an example of a new empirical approach. The hereditary predisposition for the manifestation of schizophrenialike psychoses is empirically well founded.

Affective Disorders, Psychotic

[Premorbid personality of schizophrenic patients].

This review summarizes different studies on schizophrenics regarding their premorbid personality. Schizophrenics do not average other social classes (father's profession) than endogenous or reactive depressives do, nor do they differ from the general population in that respect. On the other hand, schizophrenics show an inferior schooling achievement, as compared to depressives, and partially for that reason belong to lower social classes prior to the onset of their illness. Detailed studies of the respective social network show that schizophrenics develop in a less emancipated manner than controls, that they stick more to their families of origin, and that they engage in fewer interpersonal relationships. The latter not only are quantitatively inferior to those of healthy people, but also in quality; their relationships are often distant and alienated. In a prospective epidemiological study, 28 schizophrenics were assessed with a multi-dimensional personality test, the FPI, on average 2 years prior to the onset of their illness. The selfrating results show that schizophrenics are introverted premorbidly, as compared to control groups; it is assumed that this personality trait will be understood as "schizoid" in non-selfrating. Surprisingly, schizophrenics premorbidly have a normal neuroticism score, i.e. they are not more irritable, more aggressive, more depressive or emotionally unstable than controls.

Achievement

[The 'schizophrenic reaction'--a follow-up study after 20 years (author's transl)].

The concept of schizophrenic reaction was introduced in 1920 by Popper for single schizophrenic manifestations of short duration and full recovery, occurring after a traumatic experience. Of the 29 probands with a primary diagnosis of schizophrenic reaction when recruited for study by Rohr (report published 1961), 28 were reevaluated 20 years later. Nineteen subjects now had a clear-cut schizophrenic symptomatology (ICD 295); 16 with, and three without, remaining symptoms and/or relapse. The other nine were now diagnosed under nosologic categories other than ICD 295. Of these subjects, four were symptom free and had suffered no relapse. The study did not reveal criteria suggesting a distinguishable nosologic category 'schizophrenic reaction' with reference to a schizophrenic syndrome of acute or subacute onset after a brief traumatic event (without remaining symptoms and/or relapse). Such probands did not differ from the schizophrenic group in any of the following criteria: psychopathology, heredity data (diagnosis of relatives was undertaken without reference to the respective index cases), time of onset, duration of psychopathologic manifestation, length of hospitalization, period without remaining symptoms or relapse, and frequency and type of traumatic experiences. The two groups with schizophrenic symptomatology (ICD 295) are genetically characterized by the fact that their first-degree relatives had an incidence of schizophrenia of 8.3 +/- 2.6%. On the other hand, no certain cases of schizophrenia were found among such relatives of subjects in other diagnostic groups. The results do not support the concept of schizophrenic reaction.

Acute Disease

[Suicide and endogenous psychosis].

The frequency of suicide among a population of 675 patients with functional psychoses, within a period of observation between 9 and 24 years, was 5.5%. Suicide was the cause of death in 25.6% of all lethal outcomes. The suicide frequency of schizophrenics was 1.4%, of the bipolar cases 2.4% of the monopolar depressives 10.4%. The frequency of suicide of the parents and sibs of schizophrenics was 1.3%, of schizoaffectives 3.8%, monopolar depressives 4.2%, bipolar affective psychotics 4.3%. There was no sex difference in regard to suicide frequency but in regard to the choice of suicide means (strangulation in male, poisoning and submersion in female relatives).

Adult

[Classification of endogenous psychoses from a genetic viewpoint].

The family-heredity findings serving as criteria for the classification of functional psychoses are discussed, presenting recent data. The global morbidity risk of the resp. psychosis showing secondary cases similar (homotypical) to the index case and no increased incidence of cases of the other type may be interpreted by the theory of two separated genetically transmitted diseases (schizophrenias and affective disorders). The classical schizophrenic subtypes differ in their global schizophrenia morbidity risk and show a tendency toward homotypical secondary cases. Monopolar and bipolar affective disorders were found to be very close together concerning family-genetic data-Schizo-affective psychotics were found to have among their relatives the highest incidence of all types of functional psychoses at all, a high rate of schizophrenics (esp. catatonic type) and affective psychotics and no homotypical secondary cases.

Affective Disorders, Psychotic

[Lithium].

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Depression

[Social class and mental disorders (an empirical study in Zurich canton)].

The correlation of social class and diagnosis, therapy, mode of admission, frequency of hospitalization was tested in a population of 2103 inpatients of the two governmental and of two private mental hospitals of the Canton Zurich. The results fit to the correlations expected from the literature. The therapeutic procedures as far as reported in the case histories are mainly determined by the hospital type, not so clearly by the subject's social class. High educational status and psychotherapy are correlated. The correlation between social class and therapy is resulting of the class specific admission to one of the two hospital types. There was no sign that within one hospital patients of lower social class were placed at a disadvantage in regard to therapeutic procedures.

Educational Status

[Body oriented therapy of schizophrenic ego disturbances. Recommendation of an additional therapeutic possibility and basic thoughts on the topic].

The instrumental construction of 5 basic dimensions of ego-consciousness (ego-vitality, -activity, -consistency, -demarcation, -identity) is presented as a means of synopsis the clinical polymorphism of schizophrenic experience and behaviour. Such consideration leads to the insight how deep in their basic feelings of vitality the schizophrenic person may be endangered. From that a body-oriented therapy is conceived, which is presented in datail. The commentary of G. Benedetti points out, how in different therapeutic approaches a common basic attitude of the therapist and a unifying synthetic relationship between therapist and patient can be seen: in duality, empathic sharing of psychotic experience, symbolic realization the narcissistic deficit is overcome. The resynthesis of the ego starts from the present experience rather than from analytical interpretative historical reconstruction.

Body Image