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Objective: Which theoretical and practical competences do the neurological and psychiatric case histories of the Hippocratic Corpus convey? Material and methods: The 431 Hippocratic case histories have been studied for reports and communication on the diagnostics, treatment and prognosis of single persons and groups of patients suffering from neurological and psychiatric diseases. Results: In the 7 books of the Hippocratic Epidemics, a total of 128 patients with neurological and psychiatric symptoms are described. Epidemic fever and its variants were the leading predisposing conditions and the main symptoms were delirium, coma, insomnia, headache, speech disorders and convulsions. A number of patients with phrenitis and opisthotonos are also reported. The majority of the sick persons were male, were teenagers or adults and 47 of them are mentioned by name. The patient's information about the course is often just as informative as the doctor's observations. Treatment was limited to physical and dietary measures. Discussion: The Hippocratic physician diagnosed and attempted to treat a large number of neurological and psychiatric diseases. The often almost continuous observations of the patients led to astonishingly precise predictions of the course and the prospects of recovery. Numerous symptoms described in the case studies, including carphologia and opisthotonus, have entered the neurological vocabulary. The retrospective etiological analysis of the reports leads to the almost explicit identification of neurosyphilis and encephalitis lethargica. The therapeutic measures described by the author were, as the changeable course of the diseases shows, only of limited effectiveness despite a very differentiated application over time, both against the underlying diseases and the neurological and psychiatric complications. [ABSTRACT FROM AUTHOR]

Antidepressive pharmacotherapy has undergone various phases in its history. The euphoria of the early years on the relief of depressive symptoms was followed by a long period of clinical experience and intensive scientific work resulting in a more balanced perspective. Current debates circle around the actual effectiveness, especially with respect to long-term treatment, the prevention of suicide and the sequelae of discontinuation of an antidepressant. The evaluation of antidepressants as a group and often also the risk-benefit ratio of an individual treatment change over time. Antidepressants are typical for many forms of psychiatric treatment which, in a term from Hanfried Helmchen, are just as Janus-faced as psychiatry in a general sense is as a science and as a clinical discipline. [ABSTRACT FROM AUTHOR]

Background: Medical interaction and exploration techniques are the most important tools that medical students have to acquire in the subject of psychiatry and psychotherapy. The new digital technologies currently available, such as virtual reality (VR), as important supplements can contribute to a significant improvement in the teaching of psychiatric-psychopathological learning content as well as, in particular, the technique of ascertaining the psychiatric history and diagnosis. Objective: Evaluation of the Bochum Avatar Exploration Project (AVEX) as part of the curricular course in medical studies at the Ruhr University Bochum for its possibilities to convey learning content and techniques of anamnesis and diagnosis in the subject of psychiatry and psychotherapy. Methods: In AVEX, a total of 87 medical students in the clinical study section have so far been able to enter into a dialogue with "mentally ill" avatars and gain experience with VR technology as a learning and teaching method in the subject of psychiatry and psychotherapy. Results: Despite the limited possibilities for interaction with the digital avatars, it is possible to achieve a substantial transfer of learning content in psychiatry; however, the students must be well supported by the lecturers. Conclusion: The AVEX project already shows promising possibilities for supplementing the teaching of medical students, even if the fit of questions and replies in dialogue with the virtual avatars still needs to be improved. As advances in the linguistic communication of emotions and the visual effects of the avatar representation can be predicted, the significance of this technology will continue to increase. [ABSTRACT FROM AUTHOR]

The impacts of nature and climate change on mental health are substantial but the underlying mechanisms are still poorly understood. The immune system in particular could play an important role. Therefore, the German Center for Mental Health (DZPG) in Munich will use state of the art model systems to elucidate the role of the immune system in the pathogenesis of mental disorders under altered environmental conditions and to develop preventive treatment strategies. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic a number of ethical challenges have arisen in the healthcare system. A psychological response to moral challenges is termed moral distress (MD). Objective: Identification of causes of MD in inpatient psychiatric care in the context of the COVID-19 pandemic in Germany. Material and methods: A survey was conducted using a self-administered non-validated online questionnaire as part of a cross-sectional study, in which 26 items about the experience of MD were examined and open questions about the handling of the pandemic and its effects on everyday work were posed. Physicians who worked in inpatient psychiatric care during the COVID-19 pandemic in Germany were surveyed anonymously with a convenience sample. The data acquisition took place between 17 November 2020 and 6 May 2021. Results: A total of 141 participants were included. They indicated multiple pandemic-related changes in their daily work partly resulting in MD. Conclusion: MD is a neglected potential burden of inpatient psychiatric care under pandemic conditions (and beyond), which requires further research and an adequate handling. These results include implications for decision makers in crisis teams as well as a need for support services such as clinical ethics consultation services. [ABSTRACT FROM AUTHOR]

The German S3 guidelines on prevention of coercion: prevention and therapy of aggressive behavior in adults (2018) are cross-sectional guidelines that in addition to medical scientific evidence also touch to a great extent on questions of ethics and law as well as organizational structures of the healthcare system. Accordingly, in addition to the research on evidence, the consensus process also had a strong weighting in the development of the recommendations. The appropriate participation of experts from various fields and their representation in the consensus group was therefore of central importance. Particularly important is the implementation into clinical practice by means of the recommendations for implementation of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for psychiatric wards, psychiatric clinics, and care regions. For psychiatric wards, the recommendations are being evaluated with a multicenter randomized controlled trial (RCT), the PreVCo study. [ABSTRACT FROM AUTHOR]

Assisted suicide has been the subject of controversial debates for years, particularly intensively since a ruling by the Federal Constitutional Court of Germany (BVerfG) in 2020, which postulated that the only prerequisite for the legitimacy of assistance is the free decision to commit suicide. This brings the issue into the focus of psychiatry. On the one hand, because people with mental illnesses can seek assisted suicide and on the other hand, because these illnesses often but not necessarily limit the ability to make a free decision on suicide. In the area of tension between the medical obligation to life and to suicide prevention on the one hand and the obligation to respect autonomous decisions of patients on the other hand, psychiatrists are not only personally challenged to develop a moral stance, but also as a profession to define the role and obligations of the discipline. This overview aims to contribute to this. [ABSTRACT FROM AUTHOR]

During the era of National Socialism around 300,000 people were murdered in the "euthanasia" programs. The majority of those killings took place in asylums, whereas no killings in psychiatric and neurological university (PNU) hospitals have so far been identified. Furthermore, there were no deportations from these hospitals to the gassing asylums. Nevertheless, the PNUs took part in the "euthanasia" by transferring patients to asylums, where many of them were either killed or deported to gassing asylums. There are only a few studies that empirically describe these transfers. In this study the rates of transfers of the PNU Frankfurt am Main are reported for the first time, thus allowing a judgment of the involvement in the "euthanasia" programs. The rate of patients transferred to asylums dropped from 22–25% in the years before to around 16% in the years after knowledge about the mass killings in the asylums spread in the PNU Frankfurt. Of the patients transferred between 1940 and 1945, 53% died in the asylums before 1946. The high mortality rate of the transferred patients underlines that the role of the PNUs in the "euthanasia" programs should be examined in more detail. [ABSTRACT FROM AUTHOR]

The intensity of the research undertaken in recent decades into the killing of the sick during the Nazi period has produced a wealth of publications that will have a long-reaching impact; however, gaps in the research remain, both at regional level and with regard to the national campaign. This article focuses on the region of Pomerania, which in a whole range of ways followed its own course in the extermination of mentally ill and disabled people. It sheds light on a feature of the psychiatric landscape under the Nazis which has drawn little attention to date: the construction of the first crematorium within an asylum in the Third Reich, in 1940 in Ueckermünde. On the basis of archive material explored here for the first time, the role of the crematorium in the killing of the sick on a regional level is discussed, as is its link to the organizers of the centralized T4 campaign in Berlin. The article asks whether and to what extent there was, during the early phase of the "euthanasia" killings, a parallel regionally initiated extermination operation targeting the sick, and whether and to what extent this was tolerated or even supported by Berlin. It also provides interesting insights into the "knowledge transfer" between the head of the Ueckermünde asylum Hans-Dietrich Hilweg and the head of the asylum in Kaufbeuren, Bavaria, Valentin Faltlhauser, on how best to hide or minimize the traces of the murders. These insights clearly exemplify the transformation process postulated by Ernst Fraenkel from a normative state to a prerogative state. [ABSTRACT FROM AUTHOR]

Climate change and the resulting higher frequency of extreme weather events have a direct negative impact on mental health. Natural disasters are particularly associated with an increase in the prevalence of depression, anxiety and posttraumatic stress disorder. Indirect consequences of climate change, such as food shortages, economic crises, violent conflicts and forced migration, additionally represent severe psychological risk and stress factors. Climate anxiety and solastalgia, the distress induced by environmental change, are new psychological syndromes in the face of the existential threat posed by the climate crisis. Accordingly, a sustainable psychiatry must prepare for increasing and changing demands. The principles of psychiatric treatment need to focus more on prevention to reduce the overall burden on the healthcare system. Waste of resources and CO2 emissions in psychiatric treatment processes as well as infrastructure must be perceived and prevented. Psychiatric education, training and continuing education concepts should be expanded to include the topic of climate change in order to comprehensively inform and sensitize professionals, those affected and the public and to encourage climate-friendly and health-promoting behavior. More in-depth research is needed on the impact of climate change on mental health. The DGPPN becomes a sponsor and aims for climate neutrality by 2030 by committing to climate-friendly and energy-saving measures in the area of finance, in relation to the DGPPN congress as well as the DGPPN office. [ABSTRACT FROM AUTHOR]

Zusammenfassung: Die vorliegende Arbeit bietet Einblicke in die Rolle genetischer Diagnostik bei psychischen Erkrankungen im Erwachsenenalter. Die Bedeutung genetischer Faktoren in der Entstehung psychischer Erkrankungen und seltener genetischer Syndrome bis hin zu häufigen komplex-genetischen Erkrankungen wird beschrieben. Aktuelle wegweisende klinische Merkmale bei der Indikationsstellung stellen u. a. eine Intelligenzminderung sowie Autismusspektrumstörungen und schwere psychische Erkrankungen mit bestimmten Komorbiditäten wie Organfehlbildungen oder Epilepsien dar. Es wird erläutert, wann genetische Diagnostik leitliniengerecht infrage kommt und in welchen Situationen sie auch ohne Empfehlung in den aktuellen Leitlinien in Erwägung gezogen werden sollte. Es folgt ein Überblick über das Prozedere und derzeit gängige diagnostische Methoden. Aktuelle Limitationen und mögliche Entwicklungen im Bereich genetischer Diagnostik in der Psychiatrie werden diskutiert, inklusive der Tatsache, dass für viele psychische Erkrankungen derzeit keine genetische Diagnostik in der Klinik angestrebt werden soll. Zusammenfassend sollten in der Praxis jedoch in spezifischen klinischen Konstellationen genetische Ursachen mehr in Betracht gezogen und genetische Diagnostik und Beratung angeboten werden. [ABSTRACT FROM AUTHOR]

Background: Since the COVID-19 pandemic medical training and teaching have to adapt to the new circumstances, especially as new digital technologies become available. Physician's interaction and exploration techniques are among the most important tools that medical students have to acquire in psychiatry and psychotherapy. Objective: Virtual reality (VR) avatars can basically represent all syndromes in varying degrees of severity at any time. Material and methods: In Bochum's avatar exploration project (AVEX), students enter into dialogues with "mentally ill" avatars and, under guidance and supervision, try to work out the diagnosis, differential diagnoses and treatment recommendations. Results and discussion: This allows students to learn about rare or severe psychiatric conditions presented in VR. This review article presents first experiences especially in setting up and development as well as regarding the technological challenges. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether implementation recommendations derived from the German guidelines "Prevention of coercion" can be implemented on acute psychiatric wards by means of implementation consultants into ward work and if this contributes to an increased level of adherence to guideline intervention recommendations approved by the DGPPN (Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde)? Material and methods: Two medical or nursing experts advised ward teams on the implementation of three individually selected recommendations from the guidelines in a structured consulting process over 6 months. The degree of implementation of the recommendations was assessed before and after the intervention by the ward teams together with the implementation consultants using a tool developed for this purpose (PreVCo rating tool). Results: A total of five wards responsible for compulsorily admitted patients took part in the pilot study; three of them completed the intervention. On all three wards, implementation of the guideline recommendations improved for both selected and unselected recommendations. The strategy of using implementation consultants as well as the application of the PreVCo rating tool were well accepted and considered feasible by both the treatment teams and the implementation consultants. Conclusion: This pilot study showed that an implementation of recommendations on psychiatric wards derived from the German guidelines "Prevention of coercion" supported by implementation consultants is feasible, well acceptable among treatment teams and can lead to positive changes. The sample of five wards with diverse patient profiles was convincing. The efficacy in terms of reduction of coercive measures is currently being investigated in a randomized controlled trial on 55 psychiatric wards in different parts of Germany, with an intervention based on this pilot study. [ABSTRACT FROM AUTHOR]

Background: Previous studies among the general population indicated an association between mental illnesses and different forms of financial difficulties, such as indebtedness. Objective: Investigation of the financial burden and associated factors among inpatients and day clinic patients in psychiatric care. Material and methods: A total of 488 patients in psychiatric care in the catchment area of the Psychiatric University Hospital Charité at St. Hedwig Hospital participated in a cross-sectional patient survey carried out with a structured interview regarding financial burden, sociodemographic and clinical variables. Results: Of the participants 269 (55.1%) showed outstanding debts, loans or unpaid bills. Among the participants who were willing to give information about the amount of debts, the majority (47.0%) had debts between 1000 € and 9999 € and 36.3% between 10,000 € and 99,999 €. In the binary regression models, younger age and substance use disorders were factors significantly associated with outstanding debts. Of the participants 22.3% had outstanding debts >10,000 € and were depending on social welfare, so that indebtedness could be assumed. Conclusion: Financial burdens and outstanding debts among patients in psychiatric care should be inquired about and considered more intensively in practice. Suitable models of support need to be developed and evaluated. [ABSTRACT FROM AUTHOR]

Background: The United Nations Convention on the Rights of Persons with Disabilities and the Federal Participation Act state that all human beings have the right to choose where to live. This human right is compromised by the institutional limitations of the community psychiatric system, where persons with severe mental illnesses and with intensive support needs are often housed in closed (i.e. physically locked) living contexts. How can the concept of person-centered care help to solve this conflict? Objective: Description of the nationwide situation of closed residential facilities and discussion of the person-centered approach as a solution to the problem of closed living contexts. Methods: Summary of current knowledge on the structural and procedural data of closed residential facilities in Germany, which were collated within the framework of the "Coercive measures in the psychiatric care system—Collation and reduction" (ZIPHER) study. Results: The empirical data indicate a great need for regionally based care of the target group and a lack of individual arrangements as alternatives to closed living contexts. The necessity for regional care obligations is highlighted by the example of Mecklenburg-Western Pomerania. Conclusion: The avoidance and reduction of closed accommodation can primarily be achieved by individual arrangements within the framework of person-centered and flexible proposal landscapes. For this the service providers of integration assistance, including the psychiatric hospitals, must be committed to the care of all people in their region. An appropriate accompaniment and refunding by the service provider are also necessary. [ABSTRACT FROM AUTHOR]

Aim: To assess the structural performance of psychiatric hospitals in Germany during the COVID(coronavirus disease)-19 pandemic, a nationwide survey was launched in March 2020, in which the corona-related changes in care structures during the first wave of the pandemic were collated. Methods: Data on the care situation were collected by means of a survey in 38 out of 388 contacted psychiatric and psychotherapy hospitals in Germany over the course of 1 month. The changes and adaptations of the care structures, the type of therapy measures applied and care options for people with mental disorders and a COVID-19 infection as well as the legal basis underlying the care for patients unable to consent were documented. Results: On average, the inpatient treatment capacity of psychiatric hospitals in Germany decreased by approximately 40% compared with prepandemic periods. Day clinic and outpatient services were also only available in a limited form or were even discontinued completely. Specialized wards for patients with COVID-19 infections were available in most of the surveyed clinics (84%). Conclusion: Psychiatric hospitals were already able to respond quickly and adequately to the crisis situation in the first wave of the pandemic, e.g. by setting up COVID wards; however, the reduction in treatment capacity to 60% has significantly worsened the care situation for people with mental illnesses. Therefore, further efforts should urgently be made to adapt mental health care to the requirements of the pandemic in the long term. [ABSTRACT FROM AUTHOR]

Background: Patients with mental illnesses are at increased risk of cardiovascular disease-related mortality. Antihypertensive drugs are used particularly for the prophylaxis and treatment of cardiovascular diseases. In combination with psychiatric medication there is a potential for interaction, which can impair the achievement of therapeutic goals. Objective: The prescription behavior for antihypertensive drugs in psychiatric clinics and practices in German-speaking countries as well as the interaction potential with psychotropic drugs were investigated. Methods: The AGATE "index day" database, which anonymously stores patient data on age, sex, psychiatric main diagnosis as well as the prescribed commercial preparations collected in AGATE institutions (hospitals and community practitioners), was analyzed. The possible interactions were analyzed with PSIAC. Results: Between 1 January 2012 and 31 December 2016, 27% of all 21,980 patients recorded had a prescription for at least 1 antihypertensive drug, rising to 72% among patients over 80 years old. Of the patients treated with antihypertensive drugs, 48% received antihypertensive monotherapy. The importance of antihypertensive drug combination treatment increased with age. A median of 7 active substances were prescribed to the patients which mathematically results in 21 interactions. The simultaneous administration of psychotropic and antihypertensive drugs can result in an increased risk of hypotension, insufficient blood pressure reduction or QTc prolongation. Conclusion: Antihypertensive drugs are important in the treatment of psychiatric patients. An interaction test should be performed if pharmacotherapy is to be supplemented or changed. Where appropriate, measures to improve drug treatment safety should be considered. [ABSTRACT FROM AUTHOR]

Background: Just as the World Psychiatric Association (WPA) and other national psychiatric societies, the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has published a position statement about religiosity and spirituality in psychiatry and psychotherapy, in which it demands patient orientation and spiritual competency in psychiatric professions. Previous research has shown that lack of competency is the major barrier against implementing spiritual care into clinical practice. Objective: The aim of this study was to examine spiritual care in psychiatry and psychotherapy. An evaluation of how health professionals in psychiatry gauge the spiritual care competency of their professional group and which variables influence this judgement. Material and methods: A total of 391 psychiatric nursing personnel, 75 psychiatrists, 119 therapists from diverse professions and 62 others, i.e. 647 working in German and Austrian hospitals completed the German version of the spiritual care competency questionnaire (SCCQ). Results: Nursing personnel, older and spiritually more experienced persons gauged the spiritual competency of their own professional group comparatively higher and judged less frequently that they have no responsibility in this field. Nursing personnel reported the lack of suitable rooms as a barrier against implementation of spiritual care more often than other professional groups. Judging the spiritual competency of one's own professional group higher is associated with higher values in the SCCQ factors self-experience and proactive opening up, team spirit, perception and documentation competency. Conclusion: The responsibility of healthcare professions for spiritual care in psychiatry and psychotherapy is still a controversial issue among German-speaking psychiatric professional groups. This is partially due to a lack of competency in this domain. [ABSTRACT FROM AUTHOR]

Background: The individual needs of patients are central to hospital care. Due to the resulting complexity grouping of patients with similar therapeutic needs seems to facilitate an efficient organization of processes and the required treatment resources in hospital care. Objective: The aim of this study was to develop a system of disorder-related, treatment-oriented case groups as a possible tool for the efficient and needs-based organization of hospital care. Material and methods: The disorder-related groups were developed in a multistage, mixed-methods design. The technical content and quantitative description of the case groups and the extent of treatment included all consecutive inpatient treatment cases discharged between 1 January 2017 and 31 December 2017 from 9 psychiatric hospitals in Hesse, Germany. Results: All diagnoses in chapter F of the German modification of the International Statistical Classification of Diseases 10 (ICD-10-GM) were grouped into a total of 10 disorder-related groups. Analyses included 20,252 inpatient hospital treatment cases. Substantial management-relevant differences between the case groups could be identified and the various case group-specific configurations of clinically relevant comorbidities could be demonstrated. Discussion: The presented disorder-related grouping system and configuration of comorbidities suggest a modular organization of therapeutic measures and constitute a promising basis for needs-based management of patient care. Future work will show to what degree the disorder-related groups can facilitate a needs-specific treatment and align economic and therapeutic interests of psychiatric care. [ABSTRACT FROM AUTHOR]

In view of the current coronavirus disease 2019 (COVID-19) pandemic, patient care, including that of psychiatric patients, is facing unprecedented challenges. Treatment strategies for mental illness include psychotherapy and psychopharmacological interventions. The latter are associated with a multitude of adverse drug reactions (ADR); however, they may currently represent the preferred treatment due to restrictions regarding patient care (i.e. social distancing). Direct contact to patients may have to be reduced in favor of telephone calls or video conferences, so that new techniques in diagnosing and treating patients have to be established to guarantee patient safety. Patients should be extensively informed about relevant ADRs and physicians should actively ask patients about the timely recognition of ADRs. The use of psychotropic drugs may lead to an increased risk of developing ADRs, which are considered to be particularly unfavorable if they occur simultaneously with an acute infection or may even lead to an increased risk of infection. These include respiratory depression, agranulocytosis, intoxication by inhibition of metabolizing enzymes and venous thromboembolism, each of which may be associated with potentially fatal consequences; however, physicians should simultaneously ensure adequate efficacy of treatment, since the ongoing crisis may lead to a worsening of preexisting mental illnesses and to a surge in first onset of psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. Objective: This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. Material and methods: The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. Results: Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. Conclusion: The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high. [ABSTRACT FROM AUTHOR]

Background: Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue. Method: Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives. Results: A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of "open doors" ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards. Discussion: Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies. [ABSTRACT FROM AUTHOR]

Hintergrund und Zielsetzung: Der Gesetzgeber hat den Gemeinsamen Bundesausschuss (G-BA) nach § 136a (2) SGB V beauftragt, verbindliche Mindestvorgaben für das für die Behandlung erforderliche therapeutische Personal in stationären psychiatrischen und psychosomatischen Einrichtungen festzulegen. Dies hat die Fachgesellschaften/-verbände veranlasst, eigene konzeptionelle Überlegungen zur zukünftigen Gestaltung der Personalbemessung zu entwickeln.Methode: Durchführung regelmäßiger Expertenwerkshops, deren Ergebnisse systematisch dokumentiert und durch die Experten validiert wurden.Ergebnisse: Die wesentlichen Elemente des Konzeptes sind: Ausgangspunkt für die Berechnung der Personalausstattung sind die Bedarfe aller in der Einrichtung behandelten Patienten. Der Behandlungsbedarf hat drei Dimensionen: (a) psychiatrisch-psychotherapeutischen/psychosomatisch psychotherapeutischen/kinder- und jugendpsychiatrischen-psychotherapeutischen, (b) somatischen und (c) psychosozialen Bedarf. Das entwickelte Modell unterscheidet Personalbedarfe, die in direktem Bezug zur Behandlung des einzelnen Patienten stehen, von solchen die durch das Behandlungssetting verursacht werden und solchen, die sich auf institutioneller Ebene ergeben. Unter Mindestpersonalbedarf ist das Personaltableau zu verstehen, welches u. a. benötigt wird, um (a) die multiprofessionelle, ärztlich geleitete Behandlung und die erforderlichen Versorgungsleistungen aller Patienten sicherzustellen, die von den verfügbaren Leitlinien oder von einem Expertenkonsens vorgegeben wird, sowie (b) den Schutz des Patienten selbst, der Mitpatienten und der Mitarbeitenden der Einrichtung vor Gefährdungen zu sichern.Schlussfolgerungen: Das Modell berücksichtigt den medizinischen Fortschritt, im Sinne der evidenzbasierten Leitlinien, der veränderten Versorgungspraxis inklusive gesellschaftspolitischer Normen, die auf die Selbstbestimmung der Patienten ausgerichtet ist. [ABSTRACT FROM AUTHOR]

Weltweit gewinnen Religiosität und Spiritualität (R/S) als empirisch erfassbare und behandlungsrelevante Variablen in Psychiatrie und Psychotherapie an Bedeutung. In einer Umfrage bei den Weiterbildungsermächtigten für das Gebiet Psychiatrie und Psychotherapie in Deutschland wurde der Status quo der Integration von R/S in die Facharztweiterbildung erhoben. Es zeigt sich eine hohe Bedeutungsbeimessung für diese Themen insbesondere für existenzielle Fragen. Die persönliche Weltanschauung der Probanden (n = 285) und die Unternehmenskultur einer Weiterbildungsstätte spielen dabei eine wichtige Rolle. Diskutiert werden Selektionseffekte bei der Stichprobe und die Notwendigkeit, R/S auf der Basis wissenschaftlicher Evidenz und ethischer Erwägungen in die Weiterbildung zu integrieren. [ABSTRACT FROM AUTHOR]

Dietfried Müller-Hegemann was one of the prominent figures in East German psychiatry and psychotherapy of the 1950s and 1960s. Having been a communist prior to 1933, a resistance fighter during the National Socialist regime and having gone through political training during his exile in Soviet Russia, he proved to be a committed member of the new ruling SED socialist party in Eastern Germany. As such both governmental and party organs regarded him as a promising and reliable party member to be supported and implemented as executive staff within the new, socialist scientific system. Also, due to the fact that he supported the Pavlovian school of thought for modern psychiatry, Müller-Hegemann was installed as the new head of the Department of Neurology and Psychiatry at Leipzig University by the state secretary for higher education, notably against the clear opposition of the university medical faculty. Soon thereafter however Müller-Hegemann fell from favor due to the fact that he supported views that did not follow the strict ideological guidelines, e. g. with regard to the emergence of fascism. Moreover, he strongly opposed the separation of neurology from psychiatry as ruled by the ministry. An attempt in 1963 by junior party members and ministerial staff to remove him from office failed, but still managed to make Müller-Hegemann resign from his Leipzig post and take over that of director of the Griesinger hospital for the mentally ill in East Berlin. In May 1971, after new conflicts with party officials, he did not return from a business trip to Essen in West Germany. This study does not review the scientific and medical merits of Müller-Hegemann, but concentrates on how his career as a leading psychiatrist was manipulated, both supported and sabotaged, and ideologically controlled by the German Democratic Republic (GDR) system. His development is documented proof that party officials did not tolerate opposition, neither in ideological nor in professional questions, even if the opponent was a committed Marxist. The example of his career shows that political and ideological dissent soon melted into personal animosity and drives, as a result of which Müller-Hegemann's promising career as professor in Leipzig was terminated. [ABSTRACT FROM AUTHOR]

Background: Despite of the undisputed impact of education quality on becoming a specialist in psychiatry and psychotherapist, systematic studies in this field do not exist in Germany, apart from the evaluation of practical education by the medical councils. Materials and Methods: The Akademie-OWL, an education union of psychiatric clinics in the East Westphalia region of Germany, has provided 12-item questionnaire-based routine evaluations of theoretical education seminars since 2009. Seminars are held by consultants of psychiatry and psychotherapy within six separate weeks over a period of four years. All lecturers receive feedback from the evaluation. The results of this ongoing evaluation are presented using a typical example and in an aggregated format as a time series on the basis of one global item. Results: The data show that (1) the full range of a five-point Likert scale is used by the candidates, (2) psychiatric competences of the lecturers are more positively evaluated than their didactic competences, (3) neither within the four-years period of psychiatric education nor between different generations of candidates are systematic changes of evaluation results observed, and (4) minor to moderate differences of evaluation were observed between the different thematic fields of psychiatry and psychotherapy. Discussion: These results indicate the need of more systematic education research on establishing valid and reliable specific instruments as well as the need of systematic training of didactic competences of teaching consultants. [ABSTRACT FROM AUTHOR]

Background: The second part of the state medical examination is an essential part of medical education in Germany. From 2006 until 2013, the second and third parts of the licensing examination were combined, thus earning this examination the reputation of being notoriously difficult to pass. The aim of this exploratory study was to examine psychiatric and psychotherapeutic questions in the written part of the second examination. Objectives: This study analyzed the proportion of psychiatric and psychotherapeutic questions in the written part of the second leg of the German state medical examination. In a second step, a more detailed analysis aimed to identify more specific subject areas and to allocate diagnoses according to ICD-10, allowing a detailed overview of the presence of psychiatric topics. Material and methods: A total of 8 examinations from fall 2010 up to spring 2014 a were included in the analysis. Every examination comprised 320 questions, thus a total of 2560 questions were analyzed. All questions pertaining to psychiatric or psychotherapeutic topics were included. Questions were categorized according to a predefined set of subject areas and an ICD-10 diagnosis. Results: Out of the total of 2560 questions analyzed, 166 were categorized as being in psychiatry or psychotherapy, with each examination comprising an average of 20.75 ( SD = 5.80) relevant questions. Most questions were allocated to the subject area of pharmacology ( n = 53), followed by psychopathologic assessment ( n = 27) and psychotherapy ( n = 12). Sorted according to ICD-10 criteria, most questions could be assigned to the F3 category, the affective disorders group (21.9 %, n = 35). Conclusion: In comparison to the actual strain placed on the healthcare system, the results indicate an underrepresentation of psychiatric disorders in the second part of the German state medical examination. The distribution of specific disorders mirrors the actual distribution at least in part; however, certain practically relevant disorders are severely underrepresented. [ABSTRACT FROM AUTHOR]

Background: In Germany, several quality indicators have been proposed for the measurement of quality of mental healthcare. Some of these quality indicators have been tested in feasibility studies. The German Association for Psychiatry and Psychotherapy (DGPPN) established the 'Task Force Quality Indicators (QI)' that, based on previous experience in the development and pilot testing of indicators, considered the further development and practical realization of QI for schizophrenia. Aim: The aim was to select a set of QI for schizophrenia that can also be applied to other diagnoses or used in generic measurements. Another goal was to focus on high feasibility of indicators. Methods: In a multistage selection process, the DGPPN Task Force selected QI that focus on essential quality aspects from an inventory of 161 existing QI developed by national and international research groups. Indicators were adapted in consultation with the 'trialogic forum' of the DGPPN. Results: The DGPPN proposes the following ten indicators for quality measurement in mental healthcare for schizophrenia: QI1 Long-term treatment/Monitoring of side effects, QI2 Seclusion and restraint, QI3 Number of suicides, QI4 Psychoeducational-oriented intervention for significant others, QI5 Timely beginning of outpatient treatment after discharge from inpatient treatment, QI6 Aggression management - inpatient treatment, QI7 Diagnostic procedures/Physical examination, QI8 Antipsychotic polypharmacy, QI9 Rehabilitation/Vocational rehabilitation, QI10 Diagnostic procedures/Psychosocial functioning. Discussion: Most of our proposed QI have to be measured by means of additional data documentation. Based on prior experience in the pilot testing of QI, the DGPPN estimates that the additional efforts in data documentation would be manageable, but have to be refinanced. The indicators will be tested in feasibility studies in different mental healthcare hospitals in Germany. [ABSTRACT FROM AUTHOR]

Study objective: A simple instrument to record case-related coercive measures was tested as part of a pilot project of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). Methods: To assess coercive measures data were collected for 3 months in 8 German hospitals for psychiatry and psychotherapy. The type of measures used, the main diagnosis and the legal basis for the coercive measures were documented. Results: In the sample studied, coercive measures were applied in 8% of cases. Coercive measures were most commonly used in patients with a schizophrenic disorder. The principle of justifiable necessity according to § 34 of the German Penal Code was used particularly often as the legal basis for justifying the coercive measures. Conclusion: Suitable measurement instruments and reliable data that enable the learning of best practices represent the basis for a reduction of coercive measures. [ABSTRACT FROM AUTHOR]

In the past, the mentally ill used to be relentlessly stigmatized and their basic needs grossly neglected in China. Only the coastal cities with their Western oriented universities provided Western type mental healthcare. In general, traditional Chinese medicine (TCM) embracing medicinal herbs and acupuncture was practiced. Mental hospitals were non-existent before 1889 and care of the chronically mentally ill rested with their families and the community; however, the prevalence and spectrum of mental disorders were similar to those in Western countries. After the establishment of the People's Republic of China old-fashioned mental hospitals were founded. The 'Great Leap Forward' starting in 1958 envisaged the creation of a mental healthcare system based on Soviet Union standards. Psychiatry had a strong biological orientation, and psychotherapy did not exist. Psychology was rejected as not being science and was not taught at universities before 1978. With the Reform and Opening Policy in 1978 the education of psychology was stepped up. Psychology was introduced as an academic discipline in 1978 and psychotherapy and psychosomatic medicine were established in mental healthcare. The current mental healthcare in China resembles the standard in Germany before the 'Psychiatrie-Enquete' (expert commission official report). With the Mental Health Act adopted in 2013 after 27 years of planning, China has laid the legal foundation for planning and establishing a humane system of mental healthcare. The Act safeguards patients' human and individual rights and increases trust in psychiatric institutions. It guarantees the right to optimal treatment and provides legal protection in cases of malpractice. [ABSTRACT FROM AUTHOR]

Background: Historically, the function of psychiatry and psychotherapy in the healthcare treatment of transsexualism has been impaired by the basic assumption that non-conforming gender experiences and behavior are automatically considered as expressions of psychopathology. Objective: In line with revision of the diagnostic criteria and changing standards of care and treatment recommendations, the therapeutic relationship between mental healthcare professionals and transgender individuals is critically discussed aiming at providing a needs-based psychiatric and psychotherapeutic treatment and a patient-centered approach for trans persons. Material and methods: Literature search focusing on the prevalence of trans persons and the presence of accompanying mental disorders. Discussion of professional experiences with mental healthcare of trans persons. Results: Trans persons without clinically relevant mental distress do not need any kind of psychiatric or psychotherapeutic treatment; however, trans people with clinically relevant mental impairment need safe access to mental healthcare without linking the trans identity a priori to a mental disorder. Conclusion: In order to ensure individual trans healthcare in the long term, the therapeutic relationship should take into account both the body knowledge and self-determination of trans persons as well as the clinical expertise of mental healthcare professionals. [ABSTRACT FROM AUTHOR]

Backround: In the S3 treatment guidelines psychotherapy is recommended in all psychological disorders. Therefore, outpatient or inpatient psychotherapy should be recommended by therapists in most cases. On the other hand, it is well known that waiting periods for psychotherapeutic treatment are considerable, which raises the question how the recommendation for psychotherapy is presented in psychiatric hospitals in Germany. Objectives: The article deals with the question of how frequent the recommendation of psychotherapeutic treatment is made after psychiatric inpatient stay or day care, and if there are differences between hospitals and patient groups. Method: In four psychiatric hospitals in southern Germany the frequency of recommendation for psychotherapy in psychiatric patients was registered and compared to the number of all patients treated in the equivalent time. For this purpose, we analyzed data of the basic documentation in the four participating hospitals. Results: Overall, 9.6 % of the patients received a recommendation of psychotherapeutic treatment. In the psychiatric university hospital a subsequent psychotherapeutic treatment was recommended somewhat more often. Differences between hospitals were present but marginal. Over all participating hospitals, psychotherapy was recommended markedly less frequently in patients with an F2 diagnosis in comparison with patients with F3 or F4 diagnoses. Conclusion: Psychotherapeutic treatment after psychiatric inpatient stay is recommended cautiously. Probably therapists anticipate the fact that the growing demand for psychotherapeutic treatment in general reduces the chances for persons after psychiatric inpatient treatment. [ABSTRACT FROM AUTHOR]

Background: Waiting periods for inpatient or outpatient psychotherapeutic treatment are generally considerable. For patients treated in a psychiatric day-clinic or hospital, implementation of a recommended subsequent psychotherapeutic treatment might be difficult. Objectives: In part II of the psychotherapy after hospital or day clinic (PAKT) study, we examined how the recommendation for psychotherapy can be implemented after psychiatric treatment. Materials and methods: Three months after discharge from one of four psychiatric hospitals in southern Germany, we interviewed 306 patients who received a recommendation for psychotherapeutic treatment after their hospital stays if the recommendation was implemented successfully. Results: Only about 12 % of the patients in the follow-up group were unable to implement the general recommendation for psychotherapy after psychiatric stay despite motivation for psychotherapeutic treatment. In the case of recommendation for outpatient psychotherapy, 20 % were unsuccessful. Predictors for successful implementation were education and employment, whereas variables like age, gender, diagnosis, or severity of disorder did not play a significant role. Conclusions: The relatively small percentage of unimplemented psychotherapeutic treatment is surprising at a first glance. However, the proportion recommended for psychotherapy after psychiatric stay was less than 10 %, as shown in the first part of the study (see PAKT Study Part I, doi:s00115-016-0107-z). [ABSTRACT FROM AUTHOR]

Background: In Germany, in-patient treatment of patients with depressive, neurotic, anxiety, and somatoform disorders (ICD-10 F3, F4) is carried out in different settings in psychiatry and psychosomatics. Which patient characteristics determine referral to one or the other specialty is a crucial question in mental health policy and is a matter of ongoing controversy. However, comparative data on patient populations are widely lacking. Methods: In the study of Treatment Pathways of Patients with Anxiety and Depression (PfAD study), a total of 320 patients with ICD-10 F3/F4 clinical diagnoses were consecutively recruited from four treatment settings (psychiatric depression ward, psychiatric crisis intervention ward, psychiatric day hospitals, or psychosomatic hospital units; 80 participants per setting) and investigated. Results: In all treatment settings, patients with considerable severity of illness and chronicity were treated. Female gender, higher education, and higher income predicted referral to psychosomatic units; male gender, transfer from another hospital or emergency hospitalization, co-morbidity with a personality disorder, higher general psychiatric co-morbidity, and danger to self at admission predicted referral to psychiatric unit. Patients in psychosomatic units had neither more psychosomatic disorders nor more somatic problems. Discussion: There is considerable overlap between the clientele of psychiatric and psychosomatic units. Referral and allocation appears to be determined by aspects of severity and social status. [ABSTRACT FROM AUTHOR]

Background: Coercive measures are widely applied in psychiatric hospitals as a last resort to prevent patients seriously harming themselves or others, with negative psychological and somatic consequences for those affected. Objective: In a naturalistic observational study it was investigated whether relocation of the structural milieu of a psychiatric hospital to an architectonically improved new building influenced the application of coercive measures. Material and methods: The frequency and duration of coercive measures (e.g. fixation, coercive medication and preventive restraints) were routinely documented and compared in the periods before and after the relocation. Results: After the relocation the utilization of coercive measures was significantly reduced by 48-84 %. Conclusion: Despite the limitations of the study design the results suggest that the architectural improvements reduced the application of coercive measures. It is speculated that the positive structural milieu enhanced the well-being of patients and staff and their social relations, which in turn prevented coercive measures. [ABSTRACT FROM AUTHOR]

In the light of historical and modern criticism of the discipline of psychiatry and psychotherapy as a medical subspecialty, this paper deals with aspects of the theory of medicine as postulated by the physician and philosopher Wolfgang Wieland. According to his contributions medicine is a practical science aiming at establishing rational action. Central to this model is a diagnosis, which helps to subsume individual cases under general principles from which essential therapeutic options can be derived. Hence, psychiatry and psychotherapy become a medical subspecialty by adopting the basic model of medical reasoning and action as described by Wieland. Nevertheless, the limits of such an approach must be taken into consideration. Especially in a psychiatric and psychotherapeutic context it is of particular importance that even when being guided by general principles the responsibility for the personality of each individual patient should be adequately met. Furthermore, attention should be paid to the limits of the subspecialty of psychiatry and psychotherapy as a medical discipline, which also requires a critical analysis of the concept of psychiatric illness. [ABSTRACT FROM AUTHOR]

Background: Prior to nationwide implementation, the feasibility of newly developed quality indicators must be assessed. The aim of this multicenter feasibility test was an evaluation of the measurability of cross-sectoral quality indicators for depression and schizophrenia by means of routine data. Methods: The feasibility of the quality indicators was assessed in ten specialist clinics for psychiatry and psychotherapy by means of retrospective analyses of anonymous routine data. The data were extracted from the routine clinical documentation of the hospital information systems and the data from the admission and discharge sheets of the basic documentation in psychiatry (BADO) were additionally used for some clinics. Analyses were conducted for all cases of adults diagnosed with depression or schizophrenia within predefined assessment periods. Results: In total five indicators for depression and nine indicators for schizophrenia were assessed and evaluated as measurable or measurable to a limited extent, sometimes with slight adaptations in the operationalization of the indicator. Due to variations in documentation, some indicators could not be calculated for all clinics. Most indicators could be collated with the data from the BADO. Conclusion: An assessment of indicators that measure quality-relevant aspects of care in depression and schizophrenia, is partially feasible by means of current routine data documentation analysis from the participating clinics. However, differing documentation methodologies in the participating clinics impeded a uniform assessment; therefore, for the implementation of nationwide minimum standards for the quality assurance of mental healthcare, a uniform cross-sectoral documentation methodology should be adapted to consensus and relevant quality indicators. The BADO appears to be a suitable instrument for this purpose. [ABSTRACT FROM AUTHOR]

Background: The new compensation system for psychiatric and psychosomatic institutions (German acronym: PEPP) not only constitutes a change in billing practices, but also necessitates an ethical investigation and analysis of possible consequences of the new legislation for those affected in practice. Material and methods: Following the presentation of the new PEPP and its consequences for psychiatric practice, problems and areas of conflict will be analyzed from an ethical perspective and discussed. Results: Ethical conflicts exist in the following areas: (1) in the attempt to standardize inpatient care and invoicing for mental illnesses, (2) in poorer treatment for severely ill patients in view of degressive per diem rates, (3) in false incentives due to threshold values e.g. for 1:1 health professional-patient ratios in the case of coercive measures and (4) due to the inappropriate use of a supposed normative neutral quantitative economic model for a qualitative work area that often takes place in human border zones such as complex inpatient care of severely mentally ill patients. Conclusion: The ethical analysis of PEPP reveals that apart from the limited opportunities to improve efficiency, there is a considerable ethical risk of loss of quality in psychiatric inpatient care in particular for severely and chronically mentally ill patients. [ABSTRACT FROM AUTHOR]

The so-called recovery approach is consciously demarcated from traditional psychiatry and enforces claims to introduce a paradigmatically new view on mental healthcare. Recovery is perceived as an individual-centered activating process, enabling mentally ill persons to live with hope and meaning despite disabilities. In some countries recovery is widely used by psychiatric nurses and mental health workers and to some extent is now part of national health programs. Nevertheless, concerted discussions from a psychiatric perspective are rare and the nomenclature is sometimes vague. A brief review of the model, its theoretical roots and the discussion on whether it is novel is given. Finally, strengths and critical aspects of the approach are compared and clinical questions exemplified. [ABSTRACT FROM AUTHOR]

The conceptual history of 'anancasm' in psychiatry remains almost unexplored and this article will help to remove this deficit. It was the Budapest-based neuropsychiatrist Gyula Donáth (1849-1944) who first proposed this Greek-rooted term in 1897 as an international term for compulsive symptoms and as an independent mental illness similar to present-day obsessive compulsive disorders (ICD-10). By suggesting this term Donáth wanted to extend the concept of compulsion as proposed by his teacher Carl Westphal to other compulsive phenomena, psychomotor impulses and restrictions including echolalia, coprolalia, echokinesis, echopraxia, contemporary maladie des tics (present day Tourette's syndrome) and even intermittent dipsomania (craving for alcohol), paraphilias, sexual fetishes and homosexuality. In 1923 Kurt Schneider used this term for a subgroup of psychopathic personalities, the so-called insecure anancastic psychopaths. His concept was much different to that suggested by Donáth, with the only thing in common being the compulsory component. Schneider's anancasts suffered from feelings of insecurity and insufficiency and were forced to try to overcompensate by being excessively careful, meticulous and hyper-correct. Based on Schneider's concept anancasm has survived as a name for a subdivision of compulsive personality disorders in ICD-10; however, these rather complex personality defects were not what Donáth had in mind when he first suggested the term anancasm. The paper discusses further discrepancies between Donáth, Schneider and ICD-10. [ABSTRACT FROM AUTHOR]

Background: In Germany a new reimbursement system for psychiatry and psychosomatics is under development. Based on total costs of each case from selected hospitals and day clinics, in 2013 the Institute for the Hospital Remuneration System (InEK) proposed to reimburse the hospital costs daily with step-wise decreasing remuneration, mainly depending on the ICD-10 diagnosis, duration of stay and some complicating factors (PEPP grouper). It is controversial whether this degressive system will result in an inadequate remuneration of patients with longer duration of severe symptoms, such as suicidality in depression or autoaggressive behavior in borderline personality disorder and will eventually lead to advantages for acutely ill patients with short duration of stay compared to chronically ill patients. Objectives: This study formulated and tested an alternative remuneration system (proof of concept) mainly based on an analysis of daily cost data instead of the total costs of each case. Material and methods: The study is based on 147,749 treatment days from 4,633 cases of patients with psychotic disorders (PEPP-PA03) in 6 hospitals. As possible cost separating factors the study analyzed days with and without intensive psychiatric care, 1 to 1 care, psychological diagnostics, magnetic resonance imaging (MRI), acute crisis intervention, age at admission, the first days of treatment and day of discharge. Results and discussion: Nearly all factors tested were shown to be statistically significant in separating daily hospital costs. Based on these findings an alternative calculation algorithm (TEPPconcret), which grouped the cases with respect to age, intensive care, 1 to 1 care, treatment days 1-4 and day of discharge, was formulated and tested. For psychotic disorders TEPPconcret with a basic rate complemented by daily add-on payments depending on the effort involved, is a serious alternative to the PEPP system and awaits further evaluation. [ABSTRACT FROM AUTHOR]

Summary: Individual and collective acts of violence are mainly a male phenomenon caused by complex interactions of neurobiological and psychosocial factors. Amazingly this topic has not yet played a major role in the clinical psychiatric literature although the disastrous consequences are clearly visible everywhere and although aggression also belongs to the archaic human emotions, such as anxiety, depression and euphoria. The article gives an integrative overview on epidemiological, neurobiological, genetic, neuropathological, neurochemical/hormonal, developmental and psychosocial theories on aggression and violence, including sociocognitive models, hedonistic aspects of violence, effects of violence in the media and processes of childhood socialization. Better knowledge of the broad spectrum of these intensively interacting biological and psychosocial components resulting in violence not only improves our understanding of this calamitous psychosyndrome but can also lead to more effective preventive measures. [ABSTRACT FROM AUTHOR]

Hans Roemer (1878-1947), director of the psychiatric asylum in Illenau/Baden, was one of the few psychiatrists during National Socialism who explicitly turned against the program of systematic patient killing (euthanasia). The article gives an overview of Roemer's biography and sketches his activities in the context of reform movements in the 1920s as a protagonist in the context of the German mental hygiene movement and propagator of eugenic measures including the Nazi law of compulsory sterilization of those classified as suffering from hereditary conditions. The focus is on the beginning of the 'Aktion T4', the first phase of the systematic patient killing in 1939/1940. Roemer repeatedly tried to avert the deportation of patients from the Illenau and to find psychiatric allies for coordinated steps against the killing program. Ernst Rüdin, president of the German psychiatric association, as well as leading medical administrators blocked Roemer's initiatives. Nevertheless, Roemer did not experience any harassment or sanctions by representatives of the regime. [ABSTRACT FROM AUTHOR]

The psychiatrist and medical historian Werner Leibbrand resigned from the Berlin Medical Association after the seizure of power in protest against the exclusion of Jewish colleagues and lost both the license to practice as well as his professional position in the public health service. After the end of the war the American military authorities appointed him as expert witness for the prosecution in the Nürnberg Doctors Trial. In addition to a biographical review, Leibbrand's resolute although still undisputed attitude as ethical expert in the trials will be roughly outlined. [ABSTRACT FROM AUTHOR]