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H Dilling

Publications and source records attributed to H Dilling.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Psychiatric disorders in homeless persons--Anglo-American studies of epidemiology and management].

The state of Anglo-American research on psychiatric disorders among homeless persons is summarised. Several authors reported on life-time prevalence (50-75%) and present prevalence rates (30-50%) of psychiatric disorders in this population. Alcohol-related and drug-related disorders were most frequent. Most studies, however, only included single and male subjects, while there is little information on homeless persons living with a partner or in a family. Up to now, no representative studies exist. Some recent investigations evaluated classic single case models versus case management approaches. Short-term programmes only yielded short-term effects, but linking psychiatric and social services seems to improve health service utilization by the homeless.

Adult↗
PubMed1996

[Rooming-in in psychiatry--treatment indications and implementation].

Basing on the concept of rooming-in as the joint hospitalisation of mentally ill mothers and their children, which was developed in gynaecology and paediatrics, the differential indication, setting variables and therapeutic strategies relevant for inpatient psychotherapy were described. Therefore, 15 cases treated in the Department of Psychiatry of the Medical University Luebeck were reviewed. It will be demonstrated that a differentiated treatment approach with mothers with severe non-psychotic disorders can be realised. The advantages of the rooming-in approach seem to be on the one hand more adequate possibilities in the diagnosis and treatment of problems of mother-child interaction involving the nursing group, and on the other hand the rooming-in approach allows to identify connections between specific biographical events and actual conflicts related to birth and bringing up of the children.

Child of Impaired Parents↗
PubMed1996

Design of the ICD-10 field trial of the Diagnostic Criteria for Research in German-speaking countries.

The design of the international multicentric field trial on ICD-10, chapter V (F) "Mental and Behavioural Disorders (including disorders of psychological development): Diagnostic Criteria for Research' including some modifications for the study in German-speaking countries is described. The different stages of the study, the assessment instruments, and the database are presented.

Adult↗
PubMed1996

Mental and behavioural disorders due to use of psychoactive substances (F1). Results from the ICD-10 field trial of the Diagnostic Criteria for Research in German-speaking countries.

The results of the ICD-10 Diagnostic Criteria for Research (DCR) field trial in German-speaking countries concerning section F1 (mental and behavioural disorders due to use of psychoactive substances) show a comparatively sufficient level of acceptance. The subjective assessment of the diagnostic process and the chance-corrected interrater reliability (kappa = 0.70) are below average but quite acceptable, which is possibly due to the study design as well as the high comorbidity of disorders in this field. However, interrater reliability based on the strictly defined operationalized criteria of the DCR improved markedly compared to earlier ICD-10 field trials in German-speaking countries.

Germany↗
PubMed1996

[The career course of women and men psychiatrists].

Data from a survey distributed to all directors of psychiatric hospitals in Germany (n = 286) were used to examine sex differences in rank attainment among psychiatrists. Furthermore the directors were asked to assess differences between male and female psychiatrists concerning their professional activities. A total of 207 directors responded, 10 of them were female. In the rank of assistant doctors male psychiatrists predominated only at the university departments (61%). The position of a registrar was held mainly by male doctors in all types of hospitals: 78% at the university departments, 64% at psychiatric hospitals and 56% at psychiatric departments at general hospitals. 43.9% of the responders assessed women less interested in a professional career than men, 46.5% thought that women are more interested in treatment than in research activities, 43.5% admitted that in case of female applicants their private situation (family, children) is more important for the decision to give a job than in case of male ones. 87% of the directors found that a higher number of women within their teams is very important for a good work climate.

Career Mobility↗
PubMed1995

Mortality risk and mental disorders: longitudinal results from the Upper Bavarian Study.

The object of the study was the assessment of the mortality risk for persons with a mental disorder in an unselected representative community sample assessed longitudinally. Subjects from a rural area in Upper Bavaria (Germany) participated in semi-structured interviews conducted by research physicians in the 1970s (first assessment) and death-certificate diagnoses were obtained after an interval up to 13 years later. The sample consisted of 1668 community residents aged 15 years and over. Cox regression estimates resulted in an odds ratio of 1.35 (confidence interval 1.01 to 1.81) for persons with a mental disorder classified as marked to very severe. The odds ratio increased with increasing severity of mental illness from 1.04 from mild disorders, 1.30 for marked disorders, to 1.64 for severe or very severe disorders. The relative risk (odds ratio) for persons with a mental disorder only and no somatic disorder was 1.22, for persons with only a somatic disorder 2.00, and for those with both a mental and somatic disorder 2.13. The presence of somatic illness was responsible for most of the excess mortality. Somatic disorders associated with excess mortality in mental disorders were diseases of the nervous system or sensory organs, diseases of the circulatory system, diseases of the gastrointestinal tract, and diseases of the skeleton, muscles and connective tissue (ICD-8). Thus, while mental illness alone had a limited effect on excess mortality, comorbidity with certain somatic disorders had a significant effect.

Adolescent↗
PubMed1995

[Psychiatric diagnosis in general practice. ICD 10-Primary Health Care].

Along with Chapter V (F) of ICD-10 (International Classification of Diseases, 10th Revision) the WHO (World Health Organisation) developed a number of diagnostic instruments for different purposes. The ICD-10-PHC (Primary Health Care) is a short classification system which is to be used in general practice and primary health care. This system is tested in a worldwide field trial. The ICD-10-PHC and the study design in German-speaking countries are described in the following paper. First results of the field trial in Lübeck show that the OFFeral conception of the system was assessed useful (72%). The ease of the diagnostic process was assessed "easy" (30.4%) or "moderate" (47.6%). Between 23% and 34% of the participants of the field trial had proposals for changes. The results show that the ICD-10-PHC can hopefully lead to better standards in the treatment of psychiatric patients in primary care.

Attitude of Health Personnel↗
PubMed1995

The end of the Strecknitz asylum at Lübeck - a contribution to the social history of psychiatry during National Socialism.

At a first place the NS-policy of psychiatry is outlined -its global planning as well as its excecution. The picture is supplemented by and contrasted with its local implementation exemplified by the Strecknitz asylum at Lübeck. It becomes clear how much the global concept of the extermination of patients was interwoven with pragmatic plans of local authorities. At Lübeck only the partial identity of these interests led to the deportation of more than 600 patients. They were distributed to several transit camps in Hesse where more than 80% had died by the end of the Second World War. The main causes of death were hunger and infectious diseases - consequences of a deliberate and well-organized neglect. The behaviour and the reactions on the part of the relatives were shaped by supply shortages during the war, by internalized propaganda and by fear. The long-term effects beyond the end of the NS-regime vary a lot. Some of the relatives' coping strategies are portrayed. In some cases the murder of close family members continues to have its effects in the form of family secrets.

Concentration Camps↗
PubMed1995

[Psychiatric consultation service in a university clinic. An empirical study of characteristic performance].

In Germany, there is growing interest in consultant psychiatry on a scientific and practical level. On the other hand, very few results have been reported concerning the tasks and functions of consultant services. This study was conducted in the Lübeck University Hospital to evaluate psychiatric consultant interventions by assessing referral rates, reasons for referrals, psychiatric diagnoses and recommendations. A total of 5334 consultations from 7 years (1983-1989) was analyzed, and a sample of 1000 consultations was taken. Over the years, a continuous increase in the consultation rates can be observed, with suicide and alcoholism as important focuses. The most frequent diagnoses were adjustment disorders, organic disorders and alcoholism. Psychopharmacological intervention, referral to the psychiatric/psychosomatic ward, and short practical advice were the most frequent recommendations. The results are discussed in the context of the international literature.

Adult↗
PubMed1994

Confounding diagnostic systems: a major risk in the use of criteria-based manuals.

In psychiatry, the new classification of diseases, the ICD-10/chapter V(F), will be introduced worldwide in the near future. As in the USA in the case of the DSM-III, psychiatrists will have to change their diagnostic procedures from traditional typology to criteria orientation. 83 West German psychiatrists in practice, who were unfamiliar with the use of criteria-oriented diagnostic systems, documented not only the ICD-9 diagnoses of 10,902 depressive patients but also their DSM-III diagnoses. A comparison between the results of the diagnostic distribution of this sample and a smaller sample diagnosed by well-trained interviewers reveals that, to a great extent, systematic mistakes were made, especially by confounding typological and criteria-oriented diagnostic entities. In a vulnerable period of changing diagnostic procedures, such as during the introduction of ICD-10, facilities for training and discussion should be supplied.

Adult↗
PubMed1993

[Reference tables of WHO Chapter V (F) of the 10th revision of the International Classification of Diseases (ICD-10): ICD-9 vs. ICD-10].

With Chapter V of the Tenth Revision of the International Classification of Disease (ICD-10), the World Health Organization introduces a new classificatory approach. This instrument, which differs considerably from ICD-9, follows the principle of operational diagnosis introducing psychopathological, time- and course-related diagnostic criteria for the first time in the development of the ICD-system. Following a descriptive approach, the differentiation between psychosis and neurosis has been abandoned with the consequence of classifying the corresponding disorders under different diagnostic terms. To ensure the applicability of the new classificatory system, additional documents were developed by the Department of Mental Health of WHO. The WHO-Crosswalks, which were translated and adapted for the conditions in German-speaking countries by the authors, will provide a help concerning the classification of ICD-9 categories within ICD-10. Each diagnostic category of ICD-9 is compared with the corresponding categories in ICD-10 including a critical comment in the text.

Humans↗
PubMed1993

[Reference tables of WHO Chapter V (F) of the 10th revision of the International Classification of Diseases (ICD-10): ICD-10 vs. ICD-9].

The introduction of ICD-10, Chapter V (F) will have the consequence of a changed diagnostic spectrum and a revision of several diagnostic terms including a differentiation of several diagnostic categories. Several diagnostic categories of ICD-10 have no corresponding terms in ICD-9. Conversely, many diagnostic categories in ICD-9 are covered by several diagnostic categories in ICD-10 following phenomenological aspects as an organizing principle. Against this background the Department of Mental Health of the World Health Organization developed crosswalks between the two systems. The WHO-Crosswalks, which were translated and adapted for the conditions in German-speaking countries by the authors, will provide a help concerning the classification of ICD-9 categories within ICD-10. Each diagnostic category of ICD-9 is compared with the corresponding categories in ICD-10 including a critical comment in the text.

Humans↗
PubMed1993

[Indications for psychiatric consultation: a case-specific parallel survey of psychiatrists and treating physicians].

In a prospective study about the consultation triad (doctor-doctor-patient) 334 of 388 consecutive psychiatric consultations at two large hospitals of Lübeck within 5 months have been analyzed. The psychiatric consultant and the doctor on duty answered questions with regard to diagnosis, treatment indication and after care. 162 physicians (22 psychiatric consultants and 140 physicians working in 14 different departments) took part in the study. On one hand it turned out that there were specific indications for different diagnosis groups. On the other hand the two samples of physicians presented surprising differences with regard to their (case related) treatment indications and after care options. Psychiatrists found it less important to carry out reconsultations and the somatic orientated doctors emphasized more often psychodynamical orientated interventions for patients in contrast to the psychiatrists. Psychiatrists in contrast have been more sensitive for atmospheric tensions at the ward. These differences even grew following the amount of practice. Gerontopsychiatric patients turned out to be a special problem group. Doctors of both groups rarely share their opinion with regard to after care options.

Adult↗
PubMed1993

[Diagnosis and treatment of depressive syndromes in general practice of established neurologists. Results of an empirical study].

Data on 9956 patients concerning the diagnosis (ICD-9) and treatment of depressive syndromes were collected in psychiatric office practice. About 50% of the patients were over 50 years of age. Among all depressive disorders, neurotic and endogenous depression were found to have the highest prevalence. Amitriptyline and Doxepin were preferred in psychopharmacological treatment. Supportive Psychotherapy was practised extensively while highly structured psychoanalytical or behavioural forms of psychotherapy were relatively rare. The discussion emphasizes a methodological and epidemiological research perspective.

Adult↗
PubMed1992

[In vivo and in vitro effects of GnRH analogs on ovarian Leydig cell tumor].

A 65-year old patient, suspected to be suffering from an androgen producing ovarian tumour, was treated preoperatively with the GnRH agonist triptorelin (500 micrograms/day s.c.) for 7 days. After an initial rise, gonadotrophin levels were suppressed under this treatment. The elevated serum testosterone concentrations were reduced by approx. 50% by the triptorelin injections. After the extirpation of the tumour (histologically a Leydig cell tumour of the ovary without signs of malignancy), primary cell cultures which secreted testosterone and androstenedione were prepared. Coincubation of the tumour cells with the GnRH agonist triptorelin had no effect on their androgen secretion. Treatment of the tumour cells with high concentrations (10(-5) M) of a GnRH antagonist, however, resulted in a 100% increase of their testosterone and androstenedione secretion. GnRH-binding sites of low affinity (Ka = 0.54 x 10(5) M-1) and high capacity (B max = 1364 x 10(-12) M/mg membrane protein) were identified in the tumour. These findings suggest that GnRH analogues might modify androgen secretion of sex-cord stromal tumours of the ovary via the suppression of endogenous gonadotrophin secretion and possibly also via direct effects on the tumour cells.

Aged↗