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Biomedical subjects

K Foerster

Publications and source records attributed to K Foerster.

At least 19 recordsLinked to original sources
PubMed2003

Psychiatric commitment: patients' perspectives.

OBJECTIVE: The literature pertaining to patients' perceptions of commitment and its consequences is limited. The object of this study was to learn more about these experiences from the patient's perspective. MATERIAL AND METHODS: 108 court-committed patients (78% of whom were schizophrenic) were identified for inclusion in a retrospective follow-up study. After an interval varying from one to 4.5 years from time of commitment to follow-up, 76 patients could be contacted, of whom 47 were included in the follow-up. RESULTS: The majority of patients felt that their court commitment had not been justified and could have been avoided. Events and circumstances identified as particularly stressful about commitment were confinement in a locked ward, side effects of medication, feelings of helplessness, and certain staffbehaviors. Adverse psychological, somatic, and social consequences were common. Coercive measures during hospitalization were strongly associated with negative feelings about the effect of commitment on mental health and about subsequent treatment. The majority, however, also remained in treatment after commitment was terminated, said they would return to hospital in event of future crisis, and had pertinent comments about how commitment could have been avoided. CONCLUSIONS: Many patients who had been court-committed reported negative feelings about their experiences, but the great majority had continued in treatment, both at the termination of commitment and later. They also had ideas about how to reduce the negative impact of commitment that are worth including in future contingency plans.

Adult↗
PubMed2002

Expression of N-acetyltransferases in periodontal granulation tissue.

Smoking is a major risk of periodontal diseases. At the site of first contact, the gingiva is exposed to aromatic amines and polycyclic hydrocarbons. These are metabolized by the N-acetyltransferases (NAT), leading to local detoxification and/or activation reactions contributing to the risk of periodontal destruction in smokers. The purpose of this study was to detect the expression of N-acetyltransferase isoenzymes NAT1 and NAT2 in periodontal granulation tissue. In 24 specimens obtained from periodontitis patients or control subjects, mRNA encoding for NAT1 and NAT2 was detected by RT-PCR, and proteins were identified by immunohistochemistry. In periodontal granulation tissues, immunoreactivity for NAT1 and NAT2 was detected in infiltrating leukocytes and fibroblasts. In normal gingiva, both enzymes were found in epithelial cells, whereas NAT1 was also detected in endothelial cells. The results suggest that these enzymes may play a role in the defense against xenobiotics and the accelerated progression of periodontal disease in smokers.

Acetyltransferases↗
PubMed2000

[Is presentation of symptoms enough for detection of an illness? On the correlation between symptoms, findings, diagnosis and disability].

In 1999, the IV. civil division of the German Federal Supreme Court has issued a verdict which states that for some diseases the medical proof of a disease may be established solely on grounds of the individual complaints supporting the respective diagnosis. In the eyes of the psychiatrist, this statement is wrong and results from a confusion of diagnosis and disease. It also reveals a curious misconception of how psychiatric diagnoses, as instances of non-physical disorders, are established. Responsible for the confusion are the modern diagnostic manuals, which are misunderstood and thus misused as containing a list of diseases. However, the diagnostic manuals only intend to classify characteristic complexes of complaints and signs, without establishing them as diseases. The present paper explores the relationship between diagnosis and disease and explains how psychiatric diagnoses are made.

Disability Evaluation↗
PubMed2000

What is the benefit of involuntary short-term psychiatric hospitalisation?

In Germany, psychiatric patients considered to be a danger to themselves or others may be detained involuntarily for 24 hours, after which the court must be consulted. Only Baden-Württemberg, of all the German states, allows for 72 hours confinement. In a study of 70 patients who were involuntarily hospitalized at a university hospital, it was found that when patients are subject to a 72 hour doctors' court hold, as compared to the 24 hour hold, the number of patients committed to treatment by the court was reduced by about 50%. This applies particularly to younger patients with addiction or neurotic disorders. Schizophrenic patients and older patients with organic brain disease were more likely to be detained on court order. Two-thirds of the patients who were involuntarily hospitalized said that they felt adequately informed about their legal rights, but only about a third felt that involuntary hospitalisation was justified.

Commitment of Persons with Psychiatric Disorders↗
PubMed1999

[Need for approval of electroconvulsive therapy from the Guardian- ship Court within the context of guardianship (Section 1904 BGB)].

If patients who need electroconvulsive therapy are unable to consent, it is necessary to gain the guardian's permission to carry out the treatment. It remains unclear if, due to possible side effects, it is necessary to gain an additional approval from the Guardianship Court according to Section 1904 of German Civil Code (BGB). The high court of Hamburg (Landgericht Hamburg) decided that legal permission is necessary as a result of the risk of persisting retrograde amnesia and the ensuing danger of permanent damage to the patient's health. This paper points out however, that electroconvulsive therapy, even considering the contraindications, is a safe and effective treatment for depression and schizophrenic psychoses. Application of unilateral short-pulse stimulation reduces the frequency and intensity of cognitive side effects. In particular, retrograde amnesia is very rare with regard to frequency and intensity and is negligible when compared with the dangers of the illness itself. Therefore, it is not necessary to apply for approval from the Guardianship Court.

Amnesia↗
PubMed1996

[Amalgam--"etiology" of psychiatric disorders?].

In a liability lawsuit an expertise had to answer the question whether a mania in the course of an affective psychosis could have been caused by chronic mercury intoxication resulting from dental amalgam fillings. On the basis of current psychiatric and toxicological knowledge, such an association can be disproved. Mercury intake from amalgam fillings does not lead to toxic concentrations in organs or body fluids. Therefore physicians and dentists should avoid alarming patients and thus causing iatrogenic harm.

Adult↗
PubMed1996

[Hermann F. Hoffmann (1891-1944)--Tübingen psychiatry on the way to national socialism].

This study covers the life and scientific work of Hermann F. Hoffmann who was a disciple of Robert Gaup and in 1936 took over from him as head of the psychiatric clinic at the University of Tübinge. As a scientist, Hoffmann was especially involved in research into genetic problems in psychiatry. He introduced a new approach to some premises of the so-called Tübingen Psychiatric School. In 1933, he joined the NSDAP and became one of the most prominent members of the National Socialist party at the University of Tübingen. From then on, he saw himself as a prophet of a new "biological" philosophy of life. From the present point of view, Hoffmann is something of a contradiction. On the one hand, he was a good doctor and a serious scientist; on the other, he promoted biologistic ideology and a criminal regime. These biographical inconsistencies point to some inconsistencies in the history of psychiatry itself with its dialectics of philanthropy and discrimination.

Eugenics↗
PubMed1996

[Is the new guardianship law regarding alcoholic patients therapeutically useful? A case example].

Although treatment outcome in alcoholism is good and well documented, many patients are not sufficiently motivated for participating in a treatment program. The following case-report illustrates the example of a young male alcoholic suffering from decompensated liver cirrhoses without motivation for a long-term treatment. The positive effects of the new guidelines of the laws regulating custody and civil commitment are shown and discussed.

Adult↗
PubMed1995

[Diagnosis and management of neurotic occupational disorders (before pension application)].

This paper summarizes how neurotic disorders affect working capability, with an emphasis on neurotic working disorders. According to official statistics neurotic disorders account for 5.5% of all disability pensions, but they figure less often as diagnoses in medical certificates issued prior to invalidation. The true impact of neurotic disorders may only be guessed, since the diagnosis is easy to miss and only reluctantly proffered when suspected. In contrast to other neurotic disorder afflicting working behaviour, the neurotic working disorder is thematically centered within the sphere of work and profession itself. The disorder is often treated inadequately and belatedly. Typical somatic complaints clusters, characteristic neurotic conflicts and personality traits often encountered with neurotic working disorder are outlined. Diagnosis requires the taking of a psychobiographic history and some knowledge of psycho- and soziotherapy. There are many options for therapy, and there are a few studies evaluating their efficacy. In order to install treatment early, a routine checkup by a psychotherapist is suggested for all patients exceeding a certain number of days off work per year.

Combined Modality Therapy↗
PubMed1994

[Quality criteria in psychiatric expert practice].

Aspects of quality control are of significant importance in the field of psychiatric expertise. Better transparency and reliability should be aimed at. Formal quality criteria refer to organization, duration and extent of psychiatric exploration. Diagnosis should be made according to DSM-III-R or ICD-10 criteria. Estimation of individual degree of disability is necessary. Patients with neurotic or personality disorder require particular experience and qualification. Psychodynamic aspects of expert-patient-interaction should receive special attention. Limits of psychiatric expertise must be outlined.

Disability Evaluation↗
PubMed1993

[Psychiatric evaluation of patients with neurotic and somatoform disorders within the scope of legal disability pensions].

The problems of the psychiatric expertise of neurotic patients in the field of disability pension in the Federal Republic of Germany are described. Some main ideas for the psychiatric expert are proposed. In consideration of the therapeutic problems, preventive measures should be developed. To prevent a chronic illness, some hints for the treating physician are given. Some research problems are mentioned.

Disability Evaluation↗
PubMed1992

[Role of the physician as expert witness].

To work as a medical expert, is also a medical task, although this task produces uneasiness in many physicians. Some reasons are named. The presuppositions for the work as a medical expert are exposed. Proposals are made to improve the qualification of the experts and the quality of the expertises.

Attitude of Health Personnel↗
PubMed1992

[Psychiatric evaluation in civil law].

Aspects of civil law of importance for the psychiatrist as expert witness are those dealing with disability pensions accident insurance, compensation in civil law and rights of the seriously disabled. The legal basis of each is briefly outlined, and some guidelines given for psychiatric court reports. Some outstanding theoretical and practical problems are mentioned.

Disability Evaluation↗
PubMed1989

Findings significant with respect to short- and medium-term outcome in schizophrenia--a preliminary report.

1. The objective of the study was to determine the relationship of psychopathological, psychobiological, and clinical psychological variables to short- and medium-term outcome in schizophrenia. 2. The predictive power of several variables described as potential predictors in the literature were evaluated. To these we added clinical psychological variables; most of these had never been examined in a prospective study. 3. The sample consisted of a total of 45 patients. None of the patients was on medication and all were tested shortly after admission to the hospital. The following factors were regarded as outcome criteria: change in the GAS-score four weeks after admission, length of hospitalization after index admission, relapse nine months after admission and two years after discharge. 4. We found that the psychobiological data set as well as the clinical psychological data set had the highest predictive power with respect to short- and medium-term outcome. 5. An analysis of the single variables within the clinical psychological data set revealed that the patients with attention disorder and a low Stimulus Barrier Function (Bellak-scale) responded better to a four-week Haloperidol treatment. Patients with a low Stimulus Barrier Function at admission had, in comparison to this, a poor outcome after two years (relapse). (No patient was taking drugs regularly at this time.) The expressed emotion of the relative approached only significance (p less than .07) as a factor to be connected with relapse after two years. 6. As psychological factors the ANS activity and the CT were measured. The latter in order to evaluate possible atrophic alterations in the brain. 7. Higher activity of the ANS was found in those patients who were hospitalized for a longer period. Slight atrophic alterations of the brain (CT scan) were related to poor outcome after two years (relapse). 8. No significant relationship was found between the psychopathological state at admission and short- or medium-term course of the illness. 9. The findings are interpreted as showing the importance of psychobiological as well as clinical psychological variables in order to uncover the factors related to the heterogeneous course of the schizophrenic illness.

Emotions↗
PubMed1988

[Depressive syndromes in the involutional age and old age--a synopsis of computerized tomography, test psychologic and clinical findings].

The importance of the computertomographic, testpsychological, and clinical findings at the appearance of depressive syndromes during the involutional age and the senium has been investigated. The hypothesis is not to confirm which says that a cerebral atrophy indicated by the computer-assisted tomogram shows an unfavourable prognosis. The supposal saying that inferior results of an intelligence test (HAWIE) indicate a negative prediction was not to corroborate. By the way, patients who often had been in stationary treatment tended to show an unfavourable development (p less than 0.1) of the disease.

Aged↗
PubMed1987

[The so-called "compensation neurosis"--psychopathologic syndrome or obsolete concept?].

The problems of the muddy concept of "compensation neurosis" are demonstrated under different aspects. The following fields are discussed: terminological questions, clinical picture including psychodynamic reflections and approaches as to the course, the legal bases in the Federal Republic of Germany, in particular for the legal annuity insurance and accident insurance, and the expert's problems when giving his opinion. It is suggested no longer to use the vague and inexact formulation "compensation neurosis", but a detailed description of the symptom complex and the personality as well as the outer and inner situation should be strived after. Tasks of research are mentioned that still require to be tackled.

Germany, West↗