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Background: Due to the high disease burden, the early onset and often long-term trajectories mental disorders are among the most widespread diseases with growing significance. The German Center for Mental Health (DZPG) was established to enhance research conditions and expedite the translation of clinically relevant findings into practice. Objective: The aim of the DZPG is to optimize mental healthcare in Germany, influence modifiable social causes and to develop best practice models of care for vulnerable groups. It seeks to promote mental health and resilience, combat the stigmatization associated with mental disorders, and contribute to the enhancement of treatment across all age groups. Material and methods: The DZPG employs a translational research program that accelerates the translation of basic research findings into clinical studies and general practice. University hospitals and outpatient departments, other university disciplines, and extramural research institutions are working together to establish a collaboratively coordinated infrastructure for accelerated translation and innovation. Research priorities: The research areas encompass 1) the interaction of somatic and mental risk and resilience factors and disorders across the lifespan, 2) influencing relevant modifiable environmental factors and 3) based on this personalized prevention and intervention. Conclusion: The DZPG aims to develop innovative preventive and therapeutic tools that enable an improvement in care for individuals with mental disorders. It involves a comprehensive integration of experts with experience at all levels of decision-making and employs trilogue and participatory approaches in all research projects. [ABSTRACT FROM AUTHOR]

Aim: Stigmatization by healthcare workers poses a challenge to providing care to the mentally ill. Bedside teaching during undergraduate medical education offers students an opportunity to directly interact with patients with a range of psychiatric disorders and thereby gather reflective experience. The present study investigates if this supervised contact with mentally ill patients during a one-week clinical course on psychosomatic medicine leads to stigma reduction in medical students. The factors influencing stigmatization were also investigated. Method: This was a prospective, non-randomized, controlled interventional study done in the 2019/20 winter semester involving fourth-year medical students who attended a week-long practical block on psychosomatic medicine (intervention group). This group was compared to students who had attended a week-long practical block with a somatic focus during the same time period (control group). Stigmatization was measured before and immediately upon completion of the week using the MICA-4 scale. Data on age, sex, experience with the mentally ill, interest in psychiatry/psychosomatics, and sense of self-worth were also gathered prior to starting the practical block. Analysis of the sample of 143 students with a complete basic data set was carried out using mixed ANOVA, multiple linear regression and moderator analysis. Results: In the context of clinical teaching with psychiatric patients, the stigmatization of the mentally ill among medical students decreased significantly more in the intervention group compared to the students in the control group who received instruction on somatic topics (p=.019, η2 p =.04). In addition, being female, having previous experience with the mentally ill and general interest in the subjects of psychiatry or psychosomatics at T 0 associated with lower stigma. In contrast, stigmatization was increased at the beginning of the study in males and those with low self-esteem. A moderating effect of the factors on stigma reduction was not seen. Conclusion: Undergraduate clinical instruction that enables direct contact and reflective experiences with the mentally ill leads to a reduction in the stigmatizing attitudes held by medical students toward the mentally ill. This underscores the need to have practical clinical instruction using patients. [ABSTRACT FROM AUTHOR]

In social discourse, schizophrenia (ies) are still strongly associated with prejudices and stigmas that are characterized by irrationality and emotionality. Affected persons are confronted – besides their symptomatic burdens – with social dynamics of devaluation and isolation. These processes, which lead to stigmatization, do not only take place in the contact between the environment and the person with the diagnosis, but can also have effects on the individual self-reference of the person concerned. This article therefore focuses on mechanisms of self-stigmatization and examines the extent to which public stigmatization and attributions can be reflected in the self-reference of individuals. With the help of interviews, it was possible, on the one hand, to identify the social sphere of responsibility with regard to (self-)stigmatization. (Self-)stigmatization represents a profound social injustice towards those affected. On the other hand, the view emerged that self-stigmatization can be understood as a continuum rather than a clearly delimitable phenomenon with categorizable reactions [ABSTRACT FROM AUTHOR]

Pedophilia becomes a pedophilic disorder if the person acts upon his/her pedophilic sexual fantasies or feels distressed by these fantasies or urges. The majority of research is focused on the risk of pedophilic persons acting upon their fantasies by having sexual contacts with children or using child sexual exploitation materials. There is, however, a group of pedophilic individuals who present a low risk for sexual transgressions but but contact the prevention project Dunkelfeld (PPD) because of feelings of distress due to their pedophilia. The present article aims to shed light on this specific non-offending group by addressing the associated factors that lead to psychological distress in pedophilic individuals. In addition, a man in this subgroup describes the distress associated with his pedophilia. Lastly, the article describes the therapeutic approach used with this group and provides data on their quality of life. [ABSTRACT FROM AUTHOR]

The article describes the theoretical and conceptional background and the objectives of patient recruitment and health communication strategies applied in the prevention network Kein Täter werden (don't offend), which aims to reach people with pedophilia/hebephilia who are unknown to the justice system. The methodology, contents, and channels for influencing the participation in the preventive-therapeutic program are explained through practical examples. Furthermore, results are presented, and opportunities for further development are discussed against the background of the characteristics of the patient population reached. [ABSTRACT FROM AUTHOR]

Background: It is common practice to inform patients about causes and treatment models when starting psychiatric treatment or psychotherapy for schizophrenia. However, previous research indicates that focusing on etiological models increases stigmatizing beliefs. This raises the question of whether contemporary, medical or cognitive behavioral therapy (CBT)-based treatment models share this negative side effect. Aim: This experiment tested whether providing information about medical vs. CBT-based vs. combined treatment models affects stigmatizing attitudes towards schizophrenia and the expected efficacy of these treatments. Methods: Participants received a case vignette of a person with schizophrenia including either: (1) no treatment details, or a description of treatment with (2) medication, (3) CBT, or (4) medication and CBT. Next, stigmatizing attitudes (stereotypes, affective reactions, and desired social distance) were assessed and participants rated the perceived effectiveness of different treatment methods. Results: No treatment model showed an effect on stigmatizing attitudes. Medical and CBT treatment information (alone or in combination) had a positive effect on subjective efficacy ratings for the respective treatment. Conclusion: There appear to be no negative side effects of (biogenetic) models when presented in a context emphasizing recovery. Moreover, medication and CBT treatment information showed additive positive effects on the rating of treatment strategies. A combined treatment model integrating various evidence-based methods appears to be most useful in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Among the many reasons for the stigmatization of mental illnesses and those affected by it, the supposedly insufficient treatability plays a central role. In fact, treatability is not worse compared to various somatic diseases, although different factors impair the use and thus the effect of optimal treatment options. This is where measures to optimize treatment and care within the framework of quality psychiatry and psychotherapy come into play, whose resource-backed systematic introduction and implementation can contribute to overcoming stigma. Objective: This article examines whether and how the quality of psychiatric treatment and care can contribute to reducing stigmatizing attitudes in the general public and the stigma experienced or anticipated by persons with mental illnesses. Methods: Components of quality assured psychiatric treatment and care were identified at the conceptual level, which can hypothetically contribute to the destigmatization of persons with mental illnesses. Results and conclusion: The components of quality psychiatry that can contribute to the destigmatization of persons with mental illnesses include the implementation of regularly updated evidence-based treatment guidelines, the individualization of psychiatric treatment (precision psychiatry) and the application of quality indicators within the framework of comprehensive quality management. The postulated relationships must be empirically verified, further analyzed and communicated to the public to be made systematically useful for the destigmatization of mental illnesses. [ABSTRACT FROM AUTHOR]

Background: Despite being affected by a severe disease with increased morbidity and morality, alcohol-dependent individuals often experience stigmatizing situations in the health care system. This study aimed to investigate medical students' attitudes towards alcoholism and their readiness for cutbacks in health care expenditures for alcohol-dependent individuals. Methods: In total, 2253 students of all federal states in Germany took part in this study. Attitudes towards alcoholism, sociodemographic variables, and motives for studying medicine were assessed with an online questionnaire. Students' readiness for cutbacks in health care expenditures of alcohol-dependent individuals was measured in relation to the other diseases, including psychiatric conditions (e. g. depression, schizophrenia), potentially stigmatized non-psychiatric disorders (e. g. AIDS), and potentially lifestyle-related acute (e.g. myocardial infarction) or chronic (e. g. diabetes) conditions. Data were analyzed with hierarchical logistic regression models. Results: Compared to other medical and mental diseases, alcoholism was by far the most frequently chosen condition with a potential for financial savings. In multivariate analyses, the preference for cutbacks was associated with the increased wish for social distance, high internal attribution of responsibility, low perceived severity and personal vulnerability, the absence of alcoholism in participants' social environment, and certain motives for studying medicine. Discussion: Since the majority of alcohol-dependent individuals avoid seeking addiction-specific help, physicians in primary care are often the only contact person in the health care system who can initiate health-related behavioral changes. However, persisting prejudges may affect the physician-patient-relationship and therapy adherence. Interventions aimed at reducing stigmatizing attitudes should be implemented at an early stage of medical education. [ABSTRACT FROM AUTHOR]

Die Prävalenz von Adipositas und Übergewicht nimmt stetig zu. So wird Adipositas derzeit als eines der wichtigsten Probleme des deutschen Gesundheitssystems angesehen. Chirurgische Eingriffe sind für Patienten mit morbider Adipositas oftmals die einzige Möglichkeit, eine nachhaltige Gewichtsreduktion und Verbesserung der adipositasassoziierten Begleiterkrankungen zu erreichen. Im Hinblick auf die im Verhältnis zur Prävalenz geringe Anzahl von in Deutschland durchgeführten Adipositasoperationen werden derzeit mehrere Gründe diskutiert. Allgemeinmediziner spielen eine sehr wichtige Rolle, wenn es um Entscheidungen für oder gegen eine Behandlung geht. Bisherige Forschungsergebnisse weisen darauf hin, dass Wissen und Stigma eine Rolle spielen, wenn Behandlungspfade für Patienten mit Adipositas definiert werden. Interventionen sind erforderlich, um Behandlungsentscheidungen von Ärzten oder Patienten unabhängig von sozialem Druck aufgrund von Stigmatisierung oder Wissenslücken zu gestalten. [ABSTRACT FROM AUTHOR]

Background: Social stigma connected to mental illness is a societal problem for which we lack data, especially among children and teenagers. Objectives: The purpose of this study was to assess how adolescents stigmatize mental illness in peers and to investigate if stigmatizing attitudes differed as a function of other variables (e. g. age, gender, level of education). Materials and methods: A German translation of the Revised Attribution Questionnaire (r-AQ), a nine-item survey, was administered to 246 pupils between 14 and 16 years of age, who were recruited from seven German schools. Results: The pupils investigated in the study scored in the non-stigmatizing range of the questionnaire. Demographic factors did not have a significant effect on their stigmatizing attitude. Conclusions: The low stigmatizing tendencies can be explained by existing contact with the mentally ill or by possible effects of recruitment. Future research should take knowledge about mental illness as a possible factor influencing stigmatizing attitudes into account. [ABSTRACT FROM AUTHOR]

Stigmatisation of Alcohol Dependence: Attitudes of Alcohol-Dependent Patients During Detoxification, Medical Staff and Students Abstract. The study investigated attitudes towards people with alcohol dependency and the acceptance of neurobiological as well as social causes of the disease. Methods: The 75-item questionnaire surveyed the views of 254 participants towards alcohol-dependent people and compared attitudes of affected and healthy individuals. The persons affected by alcohol dependency (n = 122) were surveyed during an inpatient treatment program following physical withdrawal. In the comparison groups, medical staff (n = 70) as well as students without medical background knowledge (n = 62) were interviewed. Results: We did not find any differences in the attribution of neurobiological factors as causes of alcohol dependence between the affected persons and the medical staff. Students considered neurobiological factors to have less of a role in causing alcohol dependence compared to those affected and medical staff. Concerning social factors as causes of alcohol dependency, there were no significant differences between the three groups. Affected persons assessed the character characteristics of alcohol-dependent patients overall more positively than medical staff and students. Conclusion: Those affected by alcohol dependency report more positive attitudes towards people suffereing from the disease than medical staff and students with no medical or psychological background. [ABSTRACT FROM AUTHOR]

The issue of personality disorders addresses fundamental questions of psychiatry: Is there a clear boundary between normal behaviour and the state of mental illness? Which criteria are defining this boundary? Is a personality disorder really a mental illness or «just» a special variation of an individual lifestyle? This paper reviews the development of the terms psychopathy/personality disorder from the early 19"' century to the present-day diagnostic manuals ICD-10 and DSM-5. This debate spreads out - as it does with regard to any other mental disorder - between psychopathological, neurobiological and social sciences approaches. It is of high practical relevance to realize that nowadays effective therapeutic options for patients with personality disorders are available. Therefore, the therapeutic nihilism of earlier times is no longer justified. [ABSTRACT FROM AUTHOR]

Background: In medical ethics there is broad agreement that patients should be empowered to make autonomous decisions about their health and that objective, detailed information promotes these decisions. According to German law patients have a right of access to their own medical records. Objectives: Which advantages and disadvantages does the access to records have for doctors and patients in psychiatry? Which requirements should be met to make access reasonable for patients? Material and methods: This article presents an analysis of the legal situation and the state of research, evaluation of empirical studies, discussion of features of psychiatry, its language and patients as well as their influence on access to medical records. Results: Psychiatrists are sometimes concerned about patient access to medical records and some psychiatric patients feel upset or uncomfortable after having inspected their records. The misunderstanding and stigmatization of psychiatric terms, the vulnerability of psychiatric patients and the nature of psychiatric disorders, the description of which affects fundamental aspects of personality, all play a role in this. In addition, in having access to their records patients use a source of information that was originally written for other addressees. Information content and language are not adapted to their needs. Possible solutions could involve improvements in patient education and (stylistic) changes in writing records. [ABSTRACT FROM AUTHOR]

Effective psychopharmacological medication with good tolerability represents the cornerstone of treatment for severe mental illness; however, the 1-year adherence rates are only approximately 50 %. The term adherence emphasizes the collaborative responsibility of the clinician and the patient for a positive treatment outcome. Reasons for non-adherence are manifold and include patient-specific factors, such as self-stigmatization, lack of social and familial support, cognitive impairment and substance use besides insufficient effectiveness and the occurrence of side effects of the psychotropic drugs. To enhance adherence, both clinician and patient have to fully understand all the reasons for and against adherence to medication before a collaborative decision is made on future long-term treatment. A positive attitude towards medication critically depends on whether patients feel that the medication supports the attainment of the individual goals. [ABSTRACT FROM AUTHOR]

Adipositas ist gemäß den WHO-Kriterien über einen BMI von ≥ 30 kg/m2 definiert. Die Adipositasprävalenz hat in den letzten Jahren in Deutschland weiter zugenommen und liegt bei etwa 24% der Bevölkerung. Als ursächlich für die Zunahme der Adipositas werden bei zugrundeliegender genetischer Vulnerabilität vor allem die leichte Verfügbarkeit hochkalorischer Nahrungsmittel und die Bewegungsarmut in der Überflussgesellschaft angesehen. Die Grundlage jedes konservativen Gewichtsmanagements sollte ein Basisprogramm sein, das die Komponenten Ernährungs-, Bewegungs- und Verhaltenstherapie umfasst. Insgesamt sollten die Therapieziele realistisch sein und an individuelle Bedingungen angepasst werden. Dabei sollten individuelle Komorbiditäten, Risiken, Erwartungen und Ressourcen des Betroffenen stärker berücksichtigt werden und nicht nur die alleinige Gewichtsreduktion im Fokus stehen. Langfristiger Gewichtserhalt ist jedoch weiterhin schwer zu erreichen. Bei extremer Adipositas sind chirurgische Interventionen erfolgreich. Die psychische Komorbidität ist bei Menschen mit Adipositas erhöht, sowohl in der Bevölkerung als auch in klinischen Gruppen. Dies betrifft vor allem affektive Störungen, Angststörungen und Essstörungen (vor allem Binge-Eating-Störung). Auch ADHS ist mit Adipositas assoziiert, im Kindes- und Jugendlichen- wie im Erwachsenenalter. Adipositas wird in unserer Gesellschaft mehr stigmatisiert als andere körperliche und seelische Erkrankungen. [ABSTRACT FROM AUTHOR]

Language is determinative for psychiatric action, both for the understanding of the mentally ill and for treatment. More generally spoken, language also may be significant for the stigmatization of the mentally ill and of psychiatric institutions. Not least, language is the expression of the current social and cultural atmosphere, the zeitgeist. This will be demonstrated by examples of 1) the patient-physician dialogue, 2) the stigmatizing effect of words, 3) the sociopsychological mechanisms of politically correct language and 4) the change of connotations over time in unchangingly expressed terms. [ABSTRACT FROM AUTHOR]

In August 2002 the Japanese Society of Psychiatry and Neurology decided to rename the Japanese expression for schizophrenia from Sêshin Bunretsu Byô to Tôgô Shicchô Shô. Currently the psychiatric classification systems ICD-10 and DSM-IV are under revision. Against this background the Japanese process of renaming a psychiatric disorder is of high interest as far as the clinical, social and cultural implications of the new name are concerned. The authors give an overview of the Japanese process of renaming schizophrenia. Its background and realization are explained and the expectations of Japanese physicians, patients and their families related to the new name are analysed. Furthermore, its effects are evaluated. The aim of the paper is to clarify in how far the Japanese example may serve as a model for evaluating the possible implications that a renaming or nosological redefinition of schizophrenia might have in the course of the revision process of ICD 10 and DSM IV. [ABSTRACT FROM AUTHOR]

Studies on "rogue states" often present normative analyses focused on the perspective of Western actors. From a purely analytical point of view, the present article steps away from this tradition and aims to examine the process of designating actors as "rogue states", its impact on them, and their capabilities to defy stigmatization. The argument developed proceeds in two steps. Firstly, the paper discloses and discusses characteristic features of states that lead to them being labeled "rogue states." Thereby the paradoxical situation occurs that "rogue states" can be seen either as a part of the international community or as an entity being excluded from this community. Furthermore, it is emphasized that the selection process of "rogue states" is based on biased securitization policies. Secondly, despite being exposed to significant external pressure, most "rogue states" have shown a remark able resistance to transforming their political conduct. Two main sources of strength are identified: the ability of "rogue states to draw material and ideational resources from the international system and their disposal over state capacities. [ABSTRACT FROM AUTHOR]