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Objective: The variety of institutional treatments in psychiatry, as well as financial aspects make it necessary to evaluate these institutions for the quality of their medical care. At the Central Institute of Mental Health in Mannheim, the quality of treatment at the geronto-psychiatric day-clinic is assessed on the level of outcome quality., Method: The patients are examined at admission, at discharge, half a year and one year after discharge. Psychopathology, activities of daily living, social situation and quality of life are assessed by means of standardized instruments., Results: Preliminary results show that at discharge, patients are less depressed, have achieved a higher level of social activities and contacts and that their quality of life improved in most domains. In some domains of quality of life improvement is highly correlated with the amelioration of depressive symptoms, in others not., Conclusion: Whether these effects of treatment will last, has to be studied in follow-up examinations.

Anxiety is a symptom frequently encountered in elderly depressed patients. It is supposed to have an unfavourable prognostic impact. We studied the frequency of psychic anxiety and its relationship to demographic, social and clinical variables in a group of 54 elderly depressed patients admitted to a gerontopsychiatric day-clinic. Severity of depression, cognitive performance, functional level, social situation and life satisfaction were studied by means of standardized instruments. In about half of the patients studied, we found significant psychic anxiety. Compared to the other depressed patients, patients with anxiety suffered more frequently from cognitive impairment and were more dissatisfied with the acceptance of their disease by other persons. They more frequently lived together with other persons in one household. When leaving psychic anxiety out of consideration as a depressive symptom, the severity of depression was not different in patients with and without anxiety. Anxious patients were equally responsive to day-clinic treatment as non-anxious patients. However, duration of treatment was considerably increased. Thus, elderly depressed patients with anxiety show particular psychosocial and clinical features and require special attention in diagnostics and treatment.

Abnormalities of REM sleep, i.e. shortening of REM latency, lengthening of the duration of the first REM period and heightening of REM density, which are frequently observed in patients with a Major Depressive Disorder (MDD), have attracted considerable interest. Initial hopes that these aberrant patterns of sleep constitute specific markers for the primary/endogenous subtype of depression have not been fulfilled. The specificity of REM sleep disinhibition for depression in comparison to other psychopathological groups is also challenged. Demographic variables like age and sex exert strong influences on sleep physiology and must be controlled when searching for specific markers of depressed sleep. It is still an open question whether abnormalities of sleep are state-markers or trait-markers of depression. Beyond baseline studies, the cholinergic REM induction test (CRIT) indicated a heightened responsitivity of the REM sleep system to cholinergic challenge in depression compared with healthy controls and other psychopathological groups, with the exception of schizophrenia. A special role for REM sleep in depression is supported by the well known REM sleep suppressing effect of most antidepressants. The antidepressant effect of selective REM deprivation by awakenings stresses the importance of mechanisms involved in REM sleep regulation for the understanding of the pathophysiology of depressive disorders. The positive effect of total sleep deprivation on depressive mood which can be reversed by daytime naps, furthermore emphasizes relationships between sleep and depression. Experimental evidence as described above instigated several theories like the REM deprivation hypothesis, the 2-process model and the reciprocal interaction model of nonREM-REM sleep regulation to explain the deviant sleep pattern of depression. The different models will be discussed with reference to empirical data gathered in the field.

Epicondylitis is mostly related to a tendinosis found in the region of the radial or ulnar epicondylus, where the common origin of the extensor or flexor muscles is anchored. Several causes are associated with the etiopatho-genesis, most important is mechanical stress. The working hand is involved in the majority of cases. The age of the patients ranges mainly from 40-60 years. In 90% of the cases conservative measures are successful; if surgical treatment is necessary we recommend a modified version of Hohmann's operation.

The position of an operation team within the horizontal flows has to be adapted to experiences of ultra clean air technique. Managing of preparations and recommended positions at respective surgical regions are described. Important principes and orders are to 0e followed in solving problems of a horizontal flow operating tunnel.

Extensive experiences have shown that bandages of ultraviolet sensitive synthetic resin (LightCast II) offer important advantages compared to the conventional plaster cast. The special technique and details of procedure are described. The most important advantages are the light weight, water resistance (the patients can wash, shower and swim,), absolut stability is gained after 5--6 minutes under a ultraviolet lamp. Indications for the use of the fiberglass-cast are discussed.