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The paper presents the Czech-Jewish writer Josef Bor (1906–1979) and his first published book, the novel Opuštěná panenka / The Abandoned Doll (1961). Bor’s topic here was his own personal experience of the Holocaust: from his deportation to Terezín and later to Auschwitz, where he loses his entire family including two little daughters, via captivity in other concentration camps and „marches of death“ all the way to liberation, occurring in his case close to Jena, Germany. On the basis of these prominently autobiographic references, the reviewers often emphasized that the work has primarily documentary character. The present essay, on the other hand, views The Abandoned Doll primarily as a literary fiction wherein the fate of the protagonist and his family is, rather than documentary, of an exemplary, symbolic nature. The primary goal of the novel is not to represent a particular authentic case but rather to give a broad idea, anchored in a particular case, of the functioning of the Holocaust as a machinery of total humiliation and systematic killing

Objective: Assessment of the rate of false-positive results of the Structured Inventory of Malingered Symptomatology (SIMS) in healthy controls and authentic patients outside the forensic or rehabilitative context., Methods: Beyond the SIMS scores, further variables (PANSS, Hamilton scale, MMSE) were obtained. SIMS scores of healthy individuals were compared with the SIMS scores of the different groups of patients. Additionally, correlations between the SIMS scores and other variables were investigated., Results: Patients with psychotic disorders (n=30) or depressive episodes (n=32) more frequently achieved SIMS scores >16 as compared to healthy controls. In comparison, patients with amnestic disorders (n=15) had inconspicuous SIMS scores. Depressed patients with positive SIMS results were significantly more likely to be diagnosed with another psychiatric disorder and the scores of these patients on the Hamilton scale were correlated with positive results on 2 subscales of the SIMS (NI, AF)., Conclusion: If this instrument is to applied in clinical practice in the future, further validation of the SIMS is necessary. The specificity of the SIMS seems to be context-related., Competing Interests: Mathias Zink erhielt Forschungsförderung durch die Deutsche Forschungsgesellschaft (DFG) und Servier; außerdem Referentenhonorare von Lundbeck, Otsuka, Roche, Servier, Ferrer und Trommsdorff. Die anderen Autorinnen/Autoren erklären, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Routine screening using self report questionnaires for attention deficit/hyperactivity disorder (ADHD) in patients with alcohol use disorder is recommended due to its high prevalence and the time-consuming and demanding diagnostic assessment. The psychometric properties of such self-report instruments have hardly been investigated in this patient group., Methods: The performance of the ADHD self-report scale (ADHD-SR) and the German short form of the Wender Utah Rating Scale (WURS-k) was determined in 402 patients with alcohol dependence during long-term residential weaning treatment. The diagnosis of adult ADHD had been confirmed in 85 of these patients using an extensive, standardized diagnostic procedure., Results: The ADHD-SR at a cut-off ≥15 showed the best psychometric properties (sensitivity 75.3%, specificity 94.0%, positive predictive value, PPV 77.1%, negative predictive value, NPV 93.4%). The results of the WURS-k were unsatisfactory at the established cut-off ≥30 and also at lower cut-offs with more false positive screening results compared to the ADHD-SR. The combination of both instruments (ADHD-SR ≥ 15 and/or WURS-k ≥ 30) increased sensitivity (86.9%) albeit at the expense of a higher rate of false positive screening results (specificity 87.7%, PPV 65.2%)., Conclusion: The ADHD-SR is a suitable instrument for routine screening of ADHD in alcohol dependent patients. To improve sensitivity, a lower cut-off (≥15) should be applied. The WURS-k as a single screening instrument cannot be recommended in alcohol dependent patients. If a higher sensitivity is desired, a combination of ADHD-SR and WURS-k is feasible.

Background: A common disease, depression poses a significant burden both to the individual and to society. Despite the growing body of health economics research, cost studies still most frequently stem from English speaking countries. Also, even in the international literature, there is a lack of data dealing with the topic of longterm costs., Methods: All members of a health insurance company for a large chemical trust in Germany who suffered from depression (ICD 10 diagnosis F32, F33) in the year 2002 (index year) were identified (N = 591). Mean annual average costs and costs for hospital treatment, medication and sickness benefits were calculated for the index year and the years 2000 - 2005 (long term costs) and compared with those for insured persons without a psychiatric disorder. For members with new episodes beginning in the index year, the course of costs was examined., Results: With total annual costs of 4,102 euro vs. 1,103 euro in the index year and 2,380 euro vs. 792 euro for the long - term costs depressive insured are markedly more expensive. The costs for newly diagnosed patients show a clear peak in the index year, but cost differences also exist two years earlier and three years later., Conclusions: A diagnosis of depression is associated with enormous economic consequences. Especially the onset of this illness leads to a steep increase in costs. There is an urgent need to enhance primary prevention and early intervention strategies.

While Anglo-American countries increasingly integrate cost-effectiveness-studies into mental health care, in Germany there is still a basic need for empirical data with regard to the cost of care for the mentally ill. This study assesses the total cost of community mental health care of 66 schizophrenic patients prospectively over the course of 12 months. The comprehensive community care of the patients proved to be 43% of the cost of long-term treatment in a state mental hospital. Rehabilitative need, as well as living conditions and gender, showed significant influence on the total cost of community care.