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AIM: The aim of this cross sectional study was to establish the extent of psychiatric morbidity among homeless men and compare this group with a sample of formerly homeless. METHOD: [corrected] 82 homeless and a comparison group of 37 formerly homeless were interviewed using a psychopathological interview according to AMDP (Arbeitsgemeinschaft fur medizinische Dokumentation) as well as selected modules of the CIDI (Composite International Diagnostic Interview). Diagnoses were established according to ICD-10. RESULTS: The lifetime prevalence of psychiatric disorders was 95.1 %, the current prevalence was 87.8 %. Substance related disorders were the most common group of disorders. In the formerly homeless prevalences were slightly lower. CONCLUSIONS: Psychiatric morbidity among the homeless is high. Services have to be tailored to meet the needs of this special group. Formerly homeless continue to need intensive psychiatric input.

Prevalence of physical diseases, health behavior and health care utilization in single homeless men: a cross-sectional study Objective: The aim of this cross-sectional study was to establish the prevalence of physical diseases, the subjective evaluation of their own health and health care utilization in the actually homeless and a comparison group of formerly homeless. Methods: A representative sample of 82 homeless and 37 formerly homeless was studied. Instruments were a physical examination and a standardized interview. The latter included parts of the assessment of the German cardiovascular disease prevention study and the questionnaire “Funktionseinschrankungen” (functional impairments) by Potthoff (1982). Results: Disease prevalence was high. The main diagnoses fell within the categories of defective dental status (over 80%), ophthalmologic diseases (over 60%) and diseases of the liver and musculoskeletal system (over 40% each). Morbidity in the formerly homeless was even higher. In both groups the subjective evalution of their own health was unrealistically positive. Risk factors for cardiovascular diseases were high. Health care utilization was mainly acute. Conclusions: The medical care of the homeless in standard medical services is insufficient and could be improved by especially tailored projects which should include education about risk factors. Formerly homeless continue to show high disease prevalence.

On the basis of personal observations made during a recent visit to the Psychiatric University Department of Iwanowo/Russia (3/93) and on appraisal of the available literature on Russian psychiatry, the authors present a brief and critical description of the applied approaches to psychiatric care, educational standards and service structures in modern Russia.

The aim of this cross sectional study was to establish the extent of psychiatric morbidity among homeless men and compare this group with a sample of formerly homeless.[corrected] 82 homeless and a comparison group of 37 formerly homeless were interviewed using a psychopathological interview according to AMDP (Arbeitsgemeinschaft für medizinische Dokumentation) as well as selected modules of the CIDI (Composite International Diagnostic Interview). Diagnoses were established according to ICD-10.The lifetime prevalence of psychiatric disorders was 95.1 %, the current prevalence was 87.8 %. Substance related disorders were the most common group of disorders. In the formerly homeless prevalences were slightly lower.Psychiatric morbidity among the homeless is high. Services have to be tailored to meet the needs of this special group. Formerly homeless continue to need intensive psychiatric input.

The aim of this cross-sectional study was to establish the prevalence of physical diseases, the subjective evaluation of their own health and health care utilization in the actually homeless and a comparison group of formerly homeless.A representative sample of 82 homeless and 37 formerly homeless was studied. Instruments were a physical examination and a standardized interview. The latter included parts of the assessment of the German cardiovascular disease prevention study and the questionnaire "Funktionseinschränkungen" (functional impairments) by Potthoff (1982).Disease prevalence was high. The main diagnoses fell within the categories of defective dental status (over 80%), ophthalmologic diseases (over 60%) and diseases of the liver and musculoskeletal system (over 40% each). Morbidity in the formerly homeless was even higher. In both groups the subjective evaluation of their own health was unrealistically positive. Risk factors for cardiovascular diseases were high. Health care utilization was mainly acute.The medical care of the homeless in standard medical services is insufficient and could be improved by especially tailored projects which should include education about risk factors. Formerly homeless continue to show high disease prevalence.

Um das Spannungsfeld von Geschlecht und Identitat zu umreisen, sollen im letzten Teil des Buches zunachst die Ergebnisse unserer eigenen Untersuchung zusammengefasst und diskutiert werden. Dann soll noch einmal die Entwicklung und Poularisierung des Krankheitskonzeptes „Transsexualitat“ und insbesondere die damit eng verbundene Legitimierung der Behandlungsoption „medizinische Geschlechtsumwandlung“ nachgezeichnet und im Spiegel der Zeiten kritisch kommentiert werden. Schlieslich wollen wir zwei zentrale klinische Aspekte von Geschlechtsidentitatsstorungen aufgreifen, namlich die Frage nach den heute gebotenen Behandlungsempfehlungen sowie die weitere Perspektive des Storungsbildes Transsexualismus vor dem Hintergrund aktueller gesellschaftlicher Veranderungen und Umbruche im Bild der Geschlechter.

In der Abteilung fur klinische Psychiatrie und Psychotherapie der Medizinischen Hochschule Hannover und dem ihr zugeordneten Arbeitsbereich Klinische Psychologie besteht eine lange Tradition in der Behandlung von Patienten mit Geschlechtsidentitatsstorungen (Langer 1985, Desirat 1985). Anfang der neunziger Jahre wurde diese Tradition von den Verfassern durch die Etablierung einer speziellen Sprechstunde fortgefuhrt, in der Patienten mit Geschlechtsidentitatsstorungen eine ausfuhrliche Beratung sowie eine sorgfaltige diagnostische Ersteinschatzung angeboten wird. Aus der praktischen Arbeit in dieser Sprechstunde erwuchs der Plan, eine prospektive Studie durchzufuhren, um den Kenntnisstand zu den Personlichkeitsmerkmalen und den Prognosekriterien in diesem Feld zu verbessern (siehe dazu Becker, Hartmann 1994).

Mit dem Begriff „transsexuell“ werden tief in ihrer Geschlechtsidentitat gestorte Menschen bezeichnet, die sich dem ihrer Biologie kontraren Geschlecht zugehorig fuhlen und entsprechende korperliche Veranderungen anstreben. „Transsexuell“ ist dabei in der Regel eine Selbstdiagnose und fast immer verbunden mit dem Wunsch, geschlechtskorrigierende Masnahmen hormoneller sowie operativer Art zu erlangen. Seit Beginn der wissenschaftlichen Beschaftigung mit dem Phanomen der Geschlechtsidentitatsstorungen gibt es eine anhaltende Kontroverse sowohl uber die adaquate Terminologie als auch uber die angemessene Behandlung. Der Begriff Transsexualitat wurde bis zu seiner Berucksichtigung in den modernen psychiatrischen Klassifikationsschemata in sehr unterschiedlicher Definition verwendet und die Diskussion um eine angemessene Klassifikation ist weiterhin im Fluss, wie die bedeutsamen Veranderungen in der letzten Fassung des Diagnostischen and Statistischen Manuals der Amerikanischen Psychiatrischen Gesellschaft (DSM IV, 1994) zeigen.

The effects of the opioid fentanyl and low doses of alcohol on neuropsychological functions in healthy volunteers were measured. Twenty-four healthy male volunteers participated in this study. Two randomised placebo-controlled cross-over trials were conducted. In group 1, 6 subjects received fentanyl (0.2 µg/kg body weight) in the order of fentanyl/placebo and 6 subjects in the order of placebo/fentanyl. Group 2 received alcohol in a similar procedure by continuous intravenous infusion, leading to a blood alcohol concentration (BAC) of 0.03%. Impairment was measured via different neuropsychological tests. The results indicate that fentanyl in concentrations commonly used in out-patient surgical procedures produces pronounced cognitive impairment (auditory reaction time, signal detection, sustained attention, recognition) in comparison to placebo. After application of low doses of alcohol (BAC 0.03%) only visual reaction time was impaired in comparison to placebo.