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Biomedical subjects

H Helmchen

Publications and source records attributed to H Helmchen.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Psychiatric diseases and their treatment in general practice in Germany. Results of a World Health Organization (WHO) study].

As part of an international study initiated by the World Health Organization (WHO) about psychological disorders in primary health care, patients in the Federal Republic of Germany were compared with patients in other European centres. Patients from Germany do not differ from other European patients in respect to sociodemographic variables or psychiatric disorders. The most frequent CIDI-based diagnoses recorded in patients attending general practices are current depressive episodes (8.6%), generalized anxiety disorders (8.5%), neurasthenia (7.5%), and alcohol dependence (6.3%). In 20.9% of the patients at least one psychiatric diagnosis based on ICD-10 was recorded. In Germany significantly lower global ratings of health status are given than in other European centres although there is no difference in diagnostic prevalence rates. The recognition rate, i.e. the agreement between the CIDI-based ICD-10 diagnoses and the recognition as a case by the physician, is 56.2%-60.2%. On the other hand, the CIDI detects 90% of the patients described as psychologically ill by the physicians if subthreshold cases are also counted, or 46.4% if only defined diagnoses are taken into account. There is a significant correlation between severity of the psychiatric disorder and disability in social functioning. In Mainz and in the other European countries the disability rate of patients with a well-defined disorder is between 67.0% and 72.7%, whereas in Berlin this relation is not as clear, because especially in East Berlin there is a higher rate of unemployment in view of the political situation. Drug treatment is prescribed for 16.1% of the patients in primary care for psychiatric disorders. Half the patients recognized by physicians as cases receive medication. In the rest of Europe patients receive significantly more tranquillizers than in Germany, where the use of herbal drugs is more wide spread.

Adult↗
PubMed1995

[Legal liability in suicide risk from the physician's viewpoint].

Liability after physical harm or death due to a suicide attempt is mainly caused by an insufficient medical care. This is true when the known rules regarding recognition and assessment of a possible suicide as well as the selection and the realization of securing actions are not observed or deviation from such actions cannot be explained. However, such deviations have to be possible within the scope of the physician's latitude since the recognition and the treatment of a possible suicide are linked to the multitude of the actual and individual situations. The necessary risk-benefit assessment may be very difficult regarding the necessary securing actions as well as regarding the treatment.

Germany↗
PubMed1994

Structure and feasibility of a standardized stepwise drug treatment regimen (SSTR) for depressed inpatients.

"Standardized stepwise treatment regimes" (SSTR) are one way to rationally guide treatment in cases where the first treatment intervention did not yield satisfactory results. At the Department of Psychiatry of the Free University of Berlin a SSTR has been implemented into routine drug treatment for depressive disorders. The SSTR consists of eight consecutive treatment steps. If there is no sufficient change in the Bech-Rafaelsen Melancholy Scale (< 25% score reduction) in the course of two weeks, treatment has to progress to the next step. This paper describes the overall feasibility and efficacy of the strategy and the progress of the patients within the SSTR. Of those who enter the "antidepressant monotherapy phase" 52% finish treatment successfully at this stage or during the following "lithium augmentation phase". The results of this treatment-monitoring study also show that during consecutive phases of the SSTR a considerable proportion of patients in a university inpatient setting had their treatment modified according to special attitudes and clinical experiences of physicians and patients. The reasons for deviating from the SSTR obviously were more convincing than the rationale for progressing to the next step. SSTR, therefore are an important tool to give complex treatment courses a rational basis, even in patients where clinical case management requires deviations from the outlined sequence of treatment steps.

Antidepressive Agents↗
PubMed1994

Ethical problems in psychiatric everyday practice.

For the ethical evaluation of psychiatric decisions the will of the patient--apart from his welfare, of course--has gained special importance in recent years. It is constitutionally protected in the form of self-determination. Accordingly the physician can only act with the patient's consent. The capacity of the individual to consent may be impaired or suspended because of a mental disease. It is often difficult, however, to recognize this impairment, to assess its extent, to evaluate its current relevance and to draw the correct conclusions. This becomes important when the psychiatrist deals with a patient whose will is in opposition to his welfare. Difficulties for the physician may also result because his therapy, regardless of whether it is somatic therapy or psychotherapy or involves social measures, though aiming to remove the mental disturbance and with the ultimate objective of the patient regaining his lost autonomy in mind, may at times curtail the self-determination of the patient. These difficulties are illustrated by some examples with the objective to maintain our awareness of these issues in our everyday work.

Commitment of Persons with Psychiatric Disorders↗
PubMed1994

Demented subjects' competence to consent to participate in field studies: the Berlin Ageing Study.

A violation of the right to self-determination appears to be the main individual risk for participants in the Berlin Ageing Study, which is a community based non-therapeutic study with minimal health risk. In order to minimize the risk, a procedure to test the competence to consent to participate had to be introduced. To protect the participants' right to self-determination, basic capabilities of judgment and reasoning appear to be sufficient to give informed consent in this study. As a result of testing competency, 76% of the severely demented persons had to be excluded from the study, whereas a majority of the persons with mild to moderate dementia could be included.

Aged↗
PubMed1993

Adverse psychic reactions to psychotropic drugs--a report from the AMUP study.

The AMUP study (AMUP = Arzneimittelüberwachung in der Psychiatrie (Drug Monitoring in Psychiatry)) was conducted from 1979 to 1989 in order to provide for a systematic and standardized assessment of all adverse reactions to psychotropic drugs under the conditions of routine clinical treatment at two psychiatric hospitals. This paper presents data from the AMUP study on the type and frequency of adverse psychic reactions to psychotropic drug groups and relevant single drugs. Psychic ADR leading to drug discontinuation were observed in 4.5% of 15,264 inpatients monitored over an eight-year period. Only neurological ADR were more frequent (4.9%). Neuroleptics and antidepressants were involved with similar frequencies in ADR that were at least "probably" drug-related (3.3 and 3.5%). Lithium salts and benzodiazepines were only rarely involved in psychic ADR. Toxic delirium (1.0%), agitation (0.9%), and sedation (0.8%) were the most frequent single events, usually rated as "probably" drug-related. Depression and psychotic states were next in frequency, but judged as only "possibly" drug-related in a considerable proportion of cases. Haloperidol, the most common high-potency neuroleptic, was imputed mainly for depression, sedation, agitation, and (malignant) neuroleptic syndrome; with medium-potency perazine, toxic delirium and sedation prevailed; among the most common antidepressants, amitriptyline was above all connected with toxic delirium, while with clomipramine agitation predominated. The paper discusses the particular difficulties encountered in the field of psychic ADR in psychiatric patients regarding causality assessment, and emphasizes the need for continuous ADR assessment studies including state hospitals.

Adult↗
PubMed1991

[Pathobiochemistry and pharmacotherapy of alcohol withdrawal delirium].

The spectrum and time course of different symptoms during alcohol withdrawal may be caused by the involvement of various neurotransmitter systems that are differentially vulnerable to the effects of ethanol. Withdrawal symptomatology results from increased activity of excitatory mechanisms (NMDA-receptor, catecholamines among others) and from reduced functioning of inhibitory receptors (GABAA-, alpha 2-adreno-receptor among others). The neuronal mechanisms are subject to different dynamics of restitution following intoxication. Some of these probably contribute to long-lasting changes in CNS functions by "kindling" processes. Therapeutic guidelines are deduced from results of basic research and clinical trials. It is concluded that clomethiazole and benzodiazepines are superior in treating delirium tremens and certain risk-patients, whereas carbamazepine and clonidine may be helpful in moderate withdrawal syndromes or as adjunctive agents. However, the need for improved methodological standards of method in clinical research is evident.

Alcohol Withdrawal Delirium↗
PubMed1990

Summary of the qualitative criticisms made during the ICD-10 field trial and remarks on the German translation of ICD-10.

The 1987 draft of ICD-10 presents many new aspects of the psychiatric diagnostic evaluation. Some were readily accepted by the participants of the field study, including: the purely descriptive approach with the abautonment of many theoretical concepts; the more operationalized descriptions of the diagnoses; similarity in structure and terms to DSM-III-R. Others proved controversial: extension of the term dementia to include even mild and moderately severe organic psychosyndromes; inclusion of all forms of depression in one chapter, and their subdivisioning only by severity; different time criteria for the diagnosis of schizophrenia in DSM-III-R (6 months) and ICD-10 (1 month). Considerable criticism was levelled at the overly long and often tediously formulated text, and the lack of didactic organisation. A number of examples of translation difficulties are given, and the differences between a too literal and a technically correct equivalent translation disu-used.

Adolescent↗
PubMed1990

The problem of informed consent in dementia research.

The increasing frequency of dementia has considerable impact on the ill person, his relatives, and society. However, an effective therapy does not yet exist. This indicates a compelling need for dementia research. But the necessary informed consent often cannot be given by the ill person, since the dementing disease diminishes or destroys his consent capability. Possible solutions to this problem are put forward.

Aged↗