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Objective: To describe the availability of outpatient, inpatient and community based psychiatric care in 21 rural districts and 3 cities of Sachsen-Anhalt, one of the federal states of eastern Germany, with rapid changes and developments in psychiatric care over the last ten years., Method: Information about services was obtained from files of the "Committee for Issues of Psychiatric Care in Sachsen-Anhalt", which was established in 1992 with six multiprofessional "visitation groups" to perform inspections of all institutions providing psychiatric service to the community. Reports about these regular visits followed semi-standardized protocols. The ESMS was used to classify 365 institutions visited between 1996 and 1998, and numbers of places per 100 000 inhabitants were used to compare the 24 regions of the state., Results: The visitation protocols as the main source of information and the ESMS as a classification tool proved to be useful. The interrater-reliability was high, and the validity of the data was supported by other official statistics. Outpatient care was provided by 4 psychiatrists and 3 psychologists in private practice per 100 000 inhabitants, which is low compared to the German mean. 10 secure beds (forensic psychiatry), 48 acute beds, 13 elective beds and 13 day hospital places per 100 000 inhabitants were available for inpatient care, with a marked shortage of beds in the southern and eastern regions of the state. Non-acute non-hospital residential services with indefinite stay and 24 hour support accumulated to 240 places per 100 000, with regional differences ranging from less than 100 to more than 1000. About 80 % among the residents of these institutions were considered as suffering from "mental retardation", suggesting some persisting institutionalism. All other residential services taken together (time-limited or with less than 24 hour support) came to 24 places per 100 000. Sheltered workshop places corresponded to the number of persons in residential homes. Other facilities offering paid work or work-related activities were scarce; some services providing structured activity or social contact were available in urban agglomerations. The data about the frequency of contacts in outpatient and community services are limited., Conclusions: Psychiatric care in Germany is fragmentary, as regards providers and funding. Information collected by the "Committee for Issues of Psychiatric Care in Sachsen-Anhalt", taken mainly from visitation protocols, was sufficient to establish a general survey over 24 regions of this federal state. We propose to repeat this approach regularly to monitor developments in the field of social psychiatry for further planning and interventions. Overall, our results show that the aims formulated in the German "Inquiry into Psychiatry" ("Psychiatrie-Enquete") have not been fully accomplished (e.g. the preferential status of outpatient versus in-patient services).

Objective: In Germany, outpatient care is provided exclusively by physicians in private practice. This privilege is very strictly observed, with only a few exceptions. While psychiatric hospitals are routinely permitted to establish outpatient clinics, psychiatric departments of general hospitals, even if they serve a catchment area, need a formal permission of the organisation of the physicians in private practice. The law requires proof for some kind of "demand"., Method: In the catchment area of a recently founded psychiatric department of a rural general hospital, 44% of 131 medical practitioners answered a written questionnaire., Results: Psychiatrists and psychologists objected to any kind of outpatient clinic, as expected. All the general practitioners and specialists, however, supported the idea., Conclusions: Physicians practising in the area do not agree with their organization's policy. Many of them favour the possibility to have selected patients cared for at the psychiatric outpatient clinic of the local hospital.

We estimated the total neurone number, glial number, and glial index (ratio glial cells/neurone) in the thalamic mediodorsal nucleus (MD) in seven patients suffering from Huntington's disease (HD; four males, three females, mean age 52.4 +/- 13.6 years) and age- and sex-matched controls (four males, three females, mean age 53.6 +/- 12.1 years) by means of a stereological protocol. The mean total neurone number (N(T)) in the MD of controls was 2,985,188 +/- 174,710, the mean glial number (G(T); astrocytes, oligodendrocytes) 21,785,008 +/- 2,986,678, and the glial index 7.29 +/- 0.88. In HD, the average neurone number was decreased by 23.8% to 2,275,321 +/- 247,162 (Mann-Whitney U-test P < 0.05), the mean glial number by 29.7% to 15,318,895 +/- 1,722,524 (Mann-Whitney U-test P < 0.05), the glial index was slightly reduced to 6.81 +/- 1.06. Gallyas' impregnation for the demonstration of fibrous astroglia gave strongly positive results in all cases with HD and negative results in the controls. The morpho-functional correlation of the results is complicated because individual variability, presence of segregated and parallel neuronal circuits, and plasticity of the adult human CNS must be considered.

Recently, the importance of psychiatric day hospital treatment is increasing in German psychiatry, as the regionalization and community-orientation of care advance and catchment areas become smaller. When a psychiatric department of a local general hospital is within easy reach of the patient's residence, the means for intensive treatment, as is available in a hospital, can be utilized during the day, while the patient spends a considerable amount of time (in fact, two thirds) in the familiar surroundings of his/her own home. This is applicable for many psychiatric conditions, including neuroses, personality disorders and psychosomatic diseases. As compared to conventional individual outpatient psychotherapy on the one hand and a distinct limited stay in a psychosomatic sanatorium far from home on the other hand, psychotherapy in a day hospital offers a promising additional way to provide effective and lasting professional help early and with a low threshold. The article summarizes the experience gained in a newly founded department of psychiatry and psychotherapy at a general hospital in one district of eastern Germany, where the staff is struggling to meet the needs of the catchment area in spite of a too small number of hospital beds.

In 1996, the available number of hospital beds for inpatients care in psychiatry, psychotherapy and psychogeriatrics in Sachsen-Anhalt amounted to approximately 0.4 beds per 1,000 inhabitants. As compared to 1992, when most beds were still concentrated in four large psychiatric hospitals, some decentralisation had been achieved. Now, 13 of 23 catchment areas have clinical facilities of their own, five of which were newly founded. About 800 of 1,346 beds and 245 of 299 day hospital places are now located outside the former large institutions. Some of the recently established facilities, however, are not yet sufficiently equipped to serve their catchment areas, with regard to appropriate size, room, staffing, internal specialisation and authorization to cope with compulsory admissions. Even in general hospitals, psychiatric departments are often separated from the main building, with the spatial distance providing some obstacle to the desired cooperation of psychiatry with other medical specialties.