Search

Supervision im forensischen Kontext hat eine junge Geschichte. Zwar gab es in psychiatrischen Masregelvollzugskliniken schon immer Teambesprechungen, aber erst seit etwa zehn Jahren gilt externe Supervision als Bestandteil der Arbeit und ist als solche in der Psychiatrie-Personalverordnung verankert, auch wenn sie tatsachlich nicht uberall durchgefuhrt wird. Fur die Arbeit im Justizvollzug ist Supervision allerdings bis heute keineswegs selbstverstandlich, auser in den Sozialtherapeutischen Anstalten und Abteilungen. Dort ist sie wesentlicher Bestandteil professioneller Identitat, was an dem therapeutischen Selbstverstandnis dieser Spezialabteilungen liegt.

Feasibility of the educational program FAMOSES (modular service package epilepsy for families) was evaluated in a controlled pilot study. Parents of children with epilepsy from epilepsy centers in Germany were allocated to either educational group (treatment group, n=55) or waiting-list group (control group, n=48). Questionnaires included epilepsy-specific scales (knowledge, coping, adaptation, anxiety, rules and limitations, seizure management, impact of epilepsy). Multivariate analysis of variance with repeated measurements indicated significant improvements in the treatment group compared to the control group (time×group interaction: p

Epilepsy is a multifaceted and often chronic illness. Patients frequently experience social problems. These are associated with seizure severity, psychiatric comorbidities, neuropsychological dysfunctions, and various contextual factors. Contextual factors are analyzed following the International Classification of Functioning, Disability and Health, which leads to a multidimensional approach including stigma (felt and enacted), public attitudes, discrimination, and legal provisions. The literature is scarce about interventions on how to reduce these problems. In this chapter, we combine individual factors with contextual factors and introduce a new approach assessing seizure severity in categories relevant for task performance and activities. This assessment procedure, initially created for judgment of workplace risks, has been developed in cooperation with the German State Accident Insurance Agency, and thus is recognized officially. The focus lies on seizures being described in terms relevant to their effects within the demands of a specific context. Conclusions for tailored counseling for various groups of patients with respect to employment, sports, and mobility (given as examples) are drawn together with examples of rehabilitation measures. It is outlined how physicians can influence employability and social participation of patients with epilepsy. Teaching patients to evaluate their individual risk profiles can be the first, yet rather basic, step.

Using data draw from the follow-up literature covering the last 30 years, and the author's clinical data on 295 men and women after SRS, an estimation of the number of patients who regretted the operations is made. Among female-to-male transsexuals after SRS, i.e., in men, no regrets were reported in the author's sample, and in the literature they amount to less than 1%. Among male-to- female transsexuals after SRS, i.e., in women, regrets are reported in 1-1.5%. Poor differential diagnosis, failure to carry out the real-life- test, and poor surgical results seem to be the main reasons behind the regrets reported in the literature. According to three cases observed by the author in addition to personality traits the lack of proper care in treating the patients played a major role.

In Nürnberg sahen sich die arbeitsorientierten Akteure ab 2006 damit konfrontiert, die Etablierung der Metropolregion Nürnberg kritisch zu begleiten. Das Forschungsprojekt sollte diesen Prozess im Vergleich zu vier anderen (Metropol)Regionen untersu-chen. Dies betraf den Excellenz-Ansatz, der Aktivitäten nur an der internationalen Wettbewerbsfähigkeit misst und das Modell einer "Regional Governance", die gleichberechtigte Zusammenarbeit postuliert, oft aber von Wirtschaftsinteressen dominiert wird. Das Regionalmarketing ist in allen Regionen ein zentrales Thema. Clusterpolitik, Innovation sowie Verkehrsanbindung sind vielfach weitere Schwerpunkte. Fragen des Ausgleichs werden unter dem Aspekt problematisiert, ob es innerregionale Gewinner bzw. Verlierer gibt; Aspekte der sozialen Kohäsion bleiben die Ausnahme. Bei den Gestaltungsspielräumen ist es nicht die Frage des Etiketts (z.B. Metropolregion), sondern sie sind abhängig von der Ausgestaltung des Projektes. Entscheidend sind der Gestaltungswille, die Kompetenzen und die mobilisierbaren Ressourcen bei den arbeitsorientierten Akteuren.

This paper focuses on the topic of evaluation of clinical ethics consultation. The concept of evaluation seems to contain an internal tension: On the one hand, evaluation is seen (by some authors) as distorting the conceptual and normative content of the case(s) under scrutiny and, on the other, the evaluative act is the most important use of judgment and an inescapable part of everyday life (e.g., the decision to buy a certain car or eat certain food is based on our own evaluations). As such, we maintain that evaluation is essential.

Aim: The long-acting insulin analogue detemir (Levemir®) has structural and physicochemical properties which differ from human insulin. The aim of the present study was to test whether this leads to altered hormone and symptom response during hypoglycaemia. Methods: 12 healthy subjects [6f/6m, age 32 ± 6 years (mean ± s.d.), body mass index (BMI) 24.2 ± 2.5 kg/m2] underwent a 200-min stepwise hypoglycaemic clamp (45 min steps of 4.4, 3.7, 3.0 and 2.3 mmol/l) with either detemir or human insulin in random order. A bolus of detemir (660 mU/kg) or human insulin (60 mU/kg) was given before insulin was infused at a rate of 5 (detemir) or 2 (human insulin) mU/kg/min. Blood was drawn and a semi-quantitative symptom questionnaire was administered before and after each plateau of the hypoglycaemic clamp. Cognitive function was assessed during each step. Results: Blood glucose levels and glucose infusion rates were comparable with detemir and human insulin. The total symptom score was higher with detemir during the 3 and 2.3 mmol glucose step compared to human insulin (p = 0.048). Especially sweating was increased with detemir (p = 0.02) with an earlier and faster increase during the clamp (interaction insulin × time: p = 0.04). No significant differences between detemir and human insulin in cortisol, norepinephrine, epinephrine, glucagon, growth hormone, lactate or free fatty acid (FFA) levels during hypoglycaemia were observed, and there were no significant differences in cognitive function tests. Conclusions: Insulin detemir increased symptom awareness during hypoglycaemia compared to human insulin in healthy individuals, whereas counter-regulatory hormone response and cognitive function were unaltered.

Summary Aim of the study To find determinants of quality of life (QOL) in long-term follow-up after temporal lobe epilepsy (TLE) surgery in adults. Methods The QOLIE-31 questionnaire was sent to 400 of 524 patients who were operated on for refractory TLE between 1991 and 2003 in the Bethel Epilepsy Centre fulfilling the inclusion criteria of this study. Mainly patients with severe cognitive deficits and patients with progressive brain disorders were excluded. There were 222/400 patients who replied to the QOLIE-31 questionnaire and 147/222 of these patients replied to an additional questionnaire. Results Univariate analyses showed that seizure freedom, presence of auras, intake of antiepileptic drugs (AEDs), severity of AED side effects, and driving a car were significantly correlated with all subscales of QOLIE-31. Furthermore, employment status, psychiatric problems, tumors and hippocampus sclerosis pathology, the presence of a partner, age at reply, age at surgery and medical co-morbidities were significantly correlated with some subscales of the QOLIE-31. Multivariate analyses (stepwise regression analyses) revealed that especially the time since the last seizure and the severity of AED side effects had a strong impact on QOL. However, aura at last follow-up, psychiatric treatment and employment were seen in the multivariate analyses as significant predictors of some QOL subscales as well. Most subscales of QOL showed a steep, non-linear increase within the first years of seizure freedom and remained relatively stable except for cognitive function which showed continuous improvement parallel to seizure freedom. For patients who were seizure free since surgery, side effects of AED and/or psychiatric treatment were the strongest determinants of QOL. Conclusion Duration of seizure freedom and AED side effects have the strongest impact on QOL in the long-term follow-up. Therefore it is important not only to register intake of AEDs but also to assess side effects of AEDs. Persistence of auras also had an impact on different facets of QOL, but was significantly correlated with intake of AEDs. Apart from factors directly related to epilepsy QOL was dependent of psychosocial factors as employment status, psychiatric complications, and driving a car underlining the necessity of postoperative rehabilitation in this group.

Women with epilepsy are particularly affected by their condition and need therefore specific counseling and comprehensive information about issues related to contraception, pregnancy, hormone effects on seizure control, bone mineral density, etc. The primary aim of this study was to investigate the knowledge of women with epilepsy about their condition and their need for information and counseling.A total of 365 women with epilepsy aged from 16 to 75 years of age took part in this prospective, cross-sectional study. All were treated by neurologists in private practice or outpatient clinics. The physicians distributed anonymous questionnaires to the women, who mailed them unsigned to the Society for Epilepsy Research. Sociodemographic and epilepsy-specific data of the women, their experiences and fears regarding partnership, family planning, pregnancy, care of children, and their self-rated and actual knowledge were assessed.Most women (80.9%) lived together with partners, and about half of the women (44.9%) had children. The majority of those with children were greatly worried during pregnancy about risks to their newborn child. They were afraid of potential handicaps (57.9%) and potential epileptic seizures of the child (52.5%) because of their own epilepsy or antiepileptic drugs. Another 39.0% had had great reservations about becoming pregnant. About every fifth woman (18.2%) stopped or reduced antiepileptic medication during pregnancy without consulting her doctor. Women who consciously abstained from having own children (n=87, 23.8%) often reported epilepsy-related reasons (e.g. risk of malformation caused by antiepileptic drugs, 40.8%). Epilepsy also affects the mother-child relationship. For example 40.8% of the women were worried that the child could be harmed during a mother's seizure and 36% reported that their seizures would frighten their children. About 56-66% of the epileptic women stated that they were well to very well informed about topics on contraception, pregnancy, prophylaxis of malformations, and heredity of epilepsies. The knowledge questionnaires revealed however considerable knowledge deficits. These were especially widespread concerning older women and epilepsy, e.g. antiepileptic drugs and osteoporosis, and more pronounced in older women (50 years) and those with low school education. In all, self-rated and actual knowledge correlated only slightly (r=0.25). Of the women, 60% preferred personal counseling by their physicians. However, especially younger women wanted further information, primarily easy-to-understand brochures (32%) and educational courses (31%).Our results are in accordance with other studies from Great Britain and the U.S. They confirm that women with epilepsy have considerable deficits in epilepsy-specific knowledge and a great need of counselling and information.

Serotonin is frequently analysed by high-performance liquid chromatography (HPLC) with electrochemical detection. However, the accuracy of these methods may be affected by the presence of certain drugs. We describe for the first time the interference of paracetamol in therapeutic dosages in a routine HPLC method for serotonin determination in vivo and in vitro. The retention time coincides with N-methylserotonin used as an internal standard in this method. Erroneous increases of the internal standard will lead, if not recognized and corrected, to falsely low serotonin determinations.

Der Regisseur dieses Films, Fritz Lang (1890–1976), hat 43 Filme hinterlassen und zahlt zu den weltweit bedeutendsten Regisseuren, so wie der Film von vielen Fachleuten zu den 10 oder 20 besten Filmen der Welt gerechnet wird (Lang 1987). Das Drehbuch fur M — Eine Stadt sucht einen Morder (⊡ Abb. 1) schrieb Lang, damals 41 Jahre alt, zusammen mit seiner Frau Thea von Harbou. Es war sein erster Tonfilm. Bei den beiden Premierevorstellungen im Ufa-Palast am Zoo in Berlin im Mai des Jahres 1931 waren 5000 Zuschauer, und der Beifall nach den Vorstellungen wollte kein Ende nehmen. Ursprunglich sollte der Titel „Morder unter uns“ heisen, doch weigerte man sich, ihm fur einen Film mit solch einem Titel das Studio in Berlin-Staaken zur Verfugung zu stellen. Lang: „Ich wusste uberhaupt nicht, was los war. Keiner wollte mir etwas Bestimmtes sagen. Schlieslich fragte ich, was die Leute denn gegen einen Kindermorder-Film hatten — worauf die Gegenseite nun wieder sehr erstaunt war. Die hatten geglaubt, es handele sich um einen Angriff gegen die Nazis, was ich dann spater im letzten [sc. deutschsprachigen] Mabuse-Film aller- dings wirklich getan habe“ (aus einem Gesprach zwischen Fritz Lang und Erwin Kipfmuller, abgedruckt in FILM, Dezember 1956, vgl. seine Ausfuhrungen gegenuber Siegfried Kracauer 1984, S. 229). Von Lang stammen u. a. auch die Filme Dr. Mabuse, der Spieler (1922), Die Nibelungen, Teil I und II (1924), Metropolis (1927), Das Testament des Dr. Mabuse (1932/1933), Der Tiger von Eschnapur (1958), Die tausend Augen des Dr. Mabuse (1960).

Der Film Boys Don’t Cry knupft an eine reale Begebenheit an. Ende des Jahres 1993 waren auf einer Farm in der Kleinstadt Falls City, Nebraska, USA, drei Tote entdeckt worden. Sie waren erschossen worden. Einer davon war der 21-jahrige Brandon Teena, bekannt in der Stadt als Frauenheld und verspielter Rebell. Bei den polizeilichen Ermittlungen stellte sich heraus, dass Brandon Teena kein Mann, sondern eine Frau war, und ihr offizieller Name Teena Brandon. Kimberly Peirce verarbeitete diesen Stoff zu einem eindrucksvollen Low-Budget-Film, in dem die Namen der Schauplatze der Tragodie sowie der beteiligten Personen im Original ubernommen wurden. Hilary Swank spielt die Hauptrolle des Brandon Teena bzw. der Teena Brandon und wurde dafur mit dem Oscar sowie dem Golden Globe ausgezeichnet. Ihre Partnerin im Film, Chloe Sevigny, erhielt eine Oscar-Nominierung als beste Nebendarstellerin.

Summary: Purpose: To evaluate the efficacy of the e-learning course “Genetics of Epilepsies” and to assess the experiences of the participants and e-moderators with this new approach. Methods: Prospective, controlled study with waiting group (control group, n = 18) and e-learning group (n = 20). The control group got the same reference literature list as the e-learning group. Both groups were assessed twice: The e-learning group before and after the course; the control group was assessed at the same times. Primary outcome measure: increase in knowledge about genetics of epilepsies using questionnaires based on items formulated by experts (internal consistency, Cronbach's alpha = 0.86). Main hypothesis: greater increase of knowledge in the e-learning group compared to control group. Secondary outcome measures: assessment of the educational course and learning environment by participants and by tutors/e-moderators. Results: Significant time × group interaction and group effect (ANOVA, each p < 0.01) with regard to knowledge. At baseline, the groups did not differ with respect to knowledge about genetics of epilepsy. In contrast to the control group, the increase of knowledge in the e-learning group was highly significant (p < 0.001). The majority of the participants of the e-learning course was content with their personal learning process (75% agree, 15% strongly agree). Most of them reported a gain in competence in the treatment and counseling of people with epilepsy (38.9% agree, 50% strongly agree). All participants would recommend this course to others and all but one participant are interested in other e-learning courses. Conclusion: The study indicates e-learning courses are an appropriate tool to improve knowledge of physicians in genetics of epilepsy.

The role of daily living skills in forensic psychiatric patients in relation to psychotherapeutic progress and the potential reduction of dangerous behaviour has been neglected in the scientific discussion about clinical instruments for the evaluation of dangerousness and recidivism. This is mainly due to the lack of adequate observationally based instruments allowing for valid and reliable therapeutic assessments. Therefore, a new means of assessment focusing on daily living skills and social risk (the BEST-Index [Behavioural Status Index] was applied to n = 86 German forensic psychiatric patients. Two widely known actuarial instruments tapping violence risk were administered for cross validation (Psychopathy Checklist Revised [PCL-R], HCR-20). Within intervals of nine months, all instruments were applied three times. Sufficient inter rater reliability and good convergent validity of the sub-scales in relation to the actuarial instruments (HCR-20, PCL-R) could be demonstrated; supported by empirical data, clinicians working with the BEST-Index may use it to monitor behavioural change over long treatment periods. It is suggested that treatment planning and evaluation of mentally ill offenders might profit from its use.