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Previous studies indicate high prevalence rates of mental disorders and trauma among prisoners. Based on a sample of 102 male German prisoners, the comorbidity and childhood trauma experiences in 72 criminals with antisocial personality disorder were investigated. Furthermore, associations of antisocial personality disorder and early traumatic experiences with the age at first conviction and the lifetime months of imprisonment were examined. Subjects had high rates of comorbid lifetime and current disorders as well as childhood trauma experiences. Physical abuse in childhood and adolescence was identified as a predictor for lifetime months of imprisonment, antisocial personality disorder was found to be a predictor for the age at first conviction. Our findings confirm the hypothesis of prisoners with antisocial personality disorder being a severely traumatized population with serious mental disorders. Traumatic childhood experiences and antisocial personality disorder are associated with criminality variables. This has important implications on preventive treatments as well as on how prison services are addressing these problems.

Zusammenfassung {! Fragestellungen:} Welchen Langsschnittverlauf zeigen Posttraumatische Belastungsstorungen bei Holocaust-Uberlebenden? Wird dieser Verlauf durch salutogene Faktoren beeinflusst? {! Methodik:} Auf der Basis der Befunde von 600 durch auslandische arztliche Untersucher erstellte Entschadigungsgutachten werden die bei den Uberlebenden fassbaren einzelnen Anteile der Posttraumatischen Belastungsstorung aufgelistet und verschiedenartige salutogene Faktoren identifiziert. {! Ergebnisse:} Die haufigsten Symptome der Posttraumatischen Belastungsstorungen, die bei uber der Halfte der Uberlebenden nicht progredient verliefen, waren Intrusionen und Hyperarousal sowie depressive und Angststorungen. Die salutogenen Faktoren betrafen den Staat Israel, differenzierte Kommunikationen innerhalb der ehelichen Beziehungen von Uberlebenden, die Geburt von Kindern und spezielle Holocaust-Thematisierungen. {! Diskussion:} Die Korrelationen der Symptome und Verlaufe der Posttraumatischen Belastungsstorungen ein...

Basing on the concept of rooming-in as the joint hospitalisation of mentally ill mothers and their children, which was developed in gynaecology and paediatrics, the differential indication, setting variables and therapeutic strategies relevant for inpatient psychotherapy were described. Therefore, 15 cases treated in the Department of Psychiatry of the Medical University Luebeck were reviewed. It will be demonstrated that a differentiated treatment approach with mothers with severe non-psychotic disorders can be realised. The advantages of the rooming-in approach seem to be on the one hand more adequate possibilities in the diagnosis and treatment of problems of mother-child interaction involving the nursing group, and on the other hand the rooming-in approach allows to identify connections between specific biographical events and actual conflicts related to birth and bringing up of the children.

Beyond the reduction of the core symptoms, different modification patterns are expected due to differing emphases in two alternative types of treatment for bulimia nervosa: inpatient analytic and outpatient systemic therapy. The initial results of a study with a waiting-list control group are reported. Eating disorders of the bulimic women definitely improved in both therapy groups, the results for the inpatient group (n = 27) indicate a basic change in the attitude towards eating.

The long-term course of posttraumatic stress disorders was studied in Holocaust survivors. The effect of possible salutogenetic factors was also assessed.On the basis of 600 assessments by medical experts of applicants for compensation, a list of individual details of posttraumatic stress disorders as well as different salutogenetic elements are identified.In more than the half of the patients the posttraumatic stress disorders did not occur progressively. The most frequent posttraumatic stress disorder symptoms were sleep disturbances, recurrent nightmares, intrusive recollections as well as depressive and anxiety disorders. The salutogenetic factors found concerned the state of Israel, the differentiated communication within the marriage of two survivors, the birth of children and various specific holocaust-related issues.The correlations between posttraumatic stress disorder symptoms and long-term course on the one hand and salutogenetic factors on the other are discussed.

The term 'quality of life' is defined as the result of objective circumstances of life and subjective perceptions of patients. Health-related quality of life is a dynamic concept which changes during an adaptational process interacting with illness condition during the course of chronic inflammatory bowel disease. In a review on the research in this field, it is shown that quality-of-life assessment may be an important adjunct to the evaluation and treatment of patients with inflammatory bowel disease. The comparative evaluation of quality of life in patients treated medically and surgically may offer important information for decision making.

In terminologischer Hinsicht herrscht bei der sogenannten ,,vorget~iuschten St6rung" in der Literatur einige Verwirrung [1, 2]. In der ICD-10 lassen sich heimliche Selbstsch~idigungen ohne erkennbare Symptomatik an unterschiedlichen Stellen klassifizieren (Tabelle 1). Fa die patientbezogene Arbeit oi wir uns diagnostisch an der Klassifikation von Plassmann [8], der vier eigenstffndige Krankheitsbilder unterscheidet (Tabelle 2).

Objective: To examine the long-term social adaptation and long-term follow-up of bulimic women after therapy. Method: Eighty women with bulimia nervosa were investigated 7–9 years after the beginning of either conflict-oriented in-patient therapy or systemic out-patient therapy. Data was gathered through interviews and patient questionnaires. Results: At the time of follow-up, 28.9% still had DSM-III-R bulimia, 10.1% suffered from subthreshold bulimia or anorexia (EDNOS), 61.2% did not suffer from any DSM-III-R eating disorder. Compared with statistics on the normal population, the social adaptation of the women was quite good with regard to work, household and living conditions. Some dimensions representing probable aetiological factors (i.e. restrictions of intake, feelings of ineffectiveness) showed a delayed reaction to therapy. Conclusion: Long-term outcome of bulimia nervosa may be expected to be moderately good. During therapy, greater attention should be paid to characteristics of the disorder less responsive to treatment.

Basic questions concerning diagnostic models in psychoanalytic psychotherapy and psychosomatics are discussed in this paper. Against the background of the different areas in psychodynamic-oriented diagnoses, the advantages and disadvantages of descriptive multiaxial diagnostical models like DSM-III-R and ICD-10 are examined. These conceptual reflections have been built on the findings from participation in Germany of a great number of psychotherapeutic/psychosomatic institutions in the field trials for the assessment of the Diagnostic Criteria for Research of ICD-10, chapter V. Some of the most important issues this study has raised are discussed.

In 322 in-patients from 5 different departments of the hospital of the Hannover Medical School the occurrence and characteristics of psychic disorders were studied. Patients were surveyed on 11 separate wards (medicine: 3; surgery: 2; neurology: 2; ear, nose and throat: 2; orthopaedics: 2). These patients represented about 78% of the actual population of the wards during a 3-week period. There was a selection bias because severely ill and patients older than 65 years were not surveyed. The screening was done by means of 6 self-report scales which were answered on 2 consecutive days. On the basis of conservative cut-off scores the amount of depressive disorders was estimated, within 5 % confidential limits, between 16.1 and 24.9% of the patients of the total sample. Regarding the factor of social anxiety we found 20.7–30.3% of patients with this kind of disturbance. 9.3% of the patients scored high on both kinds of symptoms. So we had a total of 31.4–42.0% of patients with depressive or/and social anxiety disorders which should be treated by psychological means. In addition, all these measures varied for the patients in the 5 departments with the maximum of 49.2% in medicine and the minimum of about 32% in surgery and ear, nose and throat. These results offer a meaningful empirical basis for establishing different concepts of cooperation in the field of consultation-liaison activities. They are discussed with regard to the consequences for psychotherapeutic patient care in non-psychiatric hospital wards.

We present the psychosomatic aspects in self-help groups containing medical patients on the examples of the ostomy group. Following the demonstration of the psychodynamic group processes, the patients' psychological characteristics are described as well as the aims of this type of self-help group. The specific ostomy group activities concern the visitors' service and the group work. Finally, we describe the psychotherapeutic interventions of the psychosomaticist.

In Germany, the Balint group and the case supervision group work represent relevant instruments with regard to teaching psychosomatic medicine to physicians and allied personnel. Following a brief his

Starting from the psychosomatic patients in clinico-medical wards and the inherent two primary alexithymic features "highly limited introspective capacity' and "very low motivation concerning dynamic psychotherapy', which we proved empirically, we describe the therapist's attitude and the three steps of supportive psychotherapy which initially represent the most indicated procedure in this patient group. In Hannover, this supportive psychotherapeutic procedure is applied by student auxiliary therapists. On the basis of our empirical findings, the effectivity of supportive psychotherapy, accomplished by students, in the alexithymic psychosomatic clinico-medical inpatients could be clearly demonstrated. Furthermore, we comment on some previous psychotherapeutic findings with regard to Crohn patients. Starting from our pretreatment and our follow-up measurements, we were able to prove that patients who were treated by both supportive psychotherapy and psychoanalytically orientated inpatient ward psychotherapy, showed remarkable improvements at all levels of the measurement techniques. Finally, we outline some clinico-psychosomatic aspects with regard to secondary alexithymia.

Our considerations with regard to the psychosomatic aspects in intensive care units are begun with those psychodynamic processes which can be regularly observed in life-threatened patients; namely: depression, narcissistic disorder and oral-regressive traits, aggression defense, introspective capacity limitations as well as certain specific defense mechanisms. Furthermore, we outline the inherent indirect and direct psychotherapeutic interventions. The latter concern the supportive psychotherapy and the emergency psychotherapy. The psychotherapeutic techniques will be described in detail.

Starting from the definitions concerning the concepts 'Liaison medicine' and 'Consultative Psychiatry' we begin with remarks with regard to the Consultation Liaison-Situation in West Germany on the basis of the key-words 'Brief history', 'Independent university units with regard to Psychotherapy and Psychosomatics as well as the connected organization' and 'Teaching procedures'. Following it the Hannover Consultation Liaison model is presented particularly with regard to both the psychosomatic inpatient ward including the functional organization and psychotherapeutic processes as well as the so-called 'Innere Ambulanz' which includes the consultation liaison services in the clinico-medical departments outside Psychiatry and Psychosomatics. Within the 'Innere Ambulanz', which is closely connected to our psychosomatic inpatient ward, the consultation liaison activities and the resulting supportive psychotherapeutic strategies are performed by student auxiliary therapists who are interested in completing their 4-5 months internship-time in our department. We describe both the three supportive psychotherapeutic steps, which may last months to years including subsequent dynamically psychotherapeutic strategies as well as the reactions of the auxiliary therapist function on the students. Furthermore, we may state that there exists no one more optional education procedure of graduate students than the student's confrontation with his partial self-responsibility vis-à-vis a patient who is being supportive-psychotherapeutically treated by him. Specific empirical proofs concerning our patient oriented consultation liaison activities are demonstrated on the basis of previous psychotherapeutic findings in Crohn patients. Here we are able to demonstrate the effectivity of psychotherapy in the case of the supplementarily psychotherapeutically treated patients in comparison to the patients who received medical therapy only. Finally we are able to present quantitative clinico-medical inpatient needs with regard to consultation liaison activities starting from our 'Innere Ambulanz'. On the basis of our conservative estimate, 31-42% of patients showed severe psychosomatic or psychic symptoms who should be treated by psychological means in addition to the medical treatment.

On the background of the German situation of psychosomatic medicine as an independent department beside the psychiatric clinic, we describe the theoretical issues, organizational structure and functioning of a psychosomatic outpatient clinic. 186 consecutive referrals were analyzed. The ratio of man to woman was 1:2, mean age was 32 years (range 17-58). About half of the patients suffered from psychogenic disorders (according DSM-III criteria subsumed to the category of 'psychological factors affecting physical condition'), 21% had anxiety disturbances, and of the remaining patients 15% had affective illnesses and 13% somatoform disorders. There were three treatment conditions: inpatient psychotherapy, outpatient individual or group psychotherapy and family therapy. Follow-up results (2 years after the first contact) give some hints on the effectiveness of the different treatment procedures. The results show that the psychosomatic outpatient clinic may offer treatment for a specific patient population whose characteristics differ significantly from those of patients treated in consultation liaison services as well as by practicing psychotherapists.

We describe the consultation--liaison psychiatry activites in the renal transplant unit at Hannover Medical School. The activities with regard to patients' care include: the group session, with particular regard to dealing with the patients' denial; the indirect and direct psychotherapeutic interventions, the latter concerning psychotherapeutic consultation and counselling ('supportive psychotherapy'); and dealing with live donors and potential renal transplant patients. The second consultation--liaison psychiatry activity includes the teaching procedures: firstly, Balint-group-work with the nurses, secondly, the nurses' presence in the group sessions, and finally, Balint-group-work with students working as auxiliary therapists. In the authors' view, the field of surgery can represent a very promising one with regard to consultation--liaison psychiatry.

This contribution centers around the field of liaison teaching of medical students and describes the student’s role as auxiliary therapist. In the Hannover Medical School, the so called “Innere Ambulanz” represents a main area for the consultation-liaison psychiatric activities. The term: “Innere Ambulanz” defines the consultation-liaison activities in the clinical medical units outside of psychiatry and the department of psychosomatics. This subdivision aims at the consultation-liaison work and supplies day by day close cooperation with the medical doctors’ and nurses’ groups in their performance of their individual psychotherapy for the hospitalized patients which is supplementary to somatic therapies. In the wards there are patients suffering from the so-called psychosomatic disorders as well as those suffering from primary organic diseases who show current conflicts situation and/or marked secondary psychic changes. These two groups usually show a markedly limited introspective ability and a very low inner motivation for dynamic psychotherapy.

In the time period immediately preceding transplantation, patients have an awareness of the seriousness of their illness and tend to approach the transplant surgery with an air of expectation and optimism. In hospital units which include other patients anticipating similar surgery, patients also tend to feel secure. This security is further enhanced by the concentrated and competent care of trained transplant nurses.

Since the termination of World War II, Psychiatry has been challenged with the difficult task of the evaluation of the survivors of the Nazi persecution. The psychiatric sequelae of this era reflect direct connection between the different clinical manifestations and syndromes and the conglomeration of manifold physical and psychological traumas to which the survivors have been exposed, often during a prolonged period of time lasting through several years. The present paper examines the important but somehow neglected, and often intentionally avoided, issue: namely, the review of the problems and reactions which psychiatrists, dealing with the medical examination of survivors for the purpose of reparations' may encounter. The confrontation of the different views of psychiatric experts may frequently be complicated by deep-seated emotional issues, related to their identity. The evaluation becomes even more complex when Israeli and German experts review each others' findings. The study summarizes the different psychological mechanisms involved in the process of evaluation. Pitfalls related to inadequate use of mechanisms of defence are pointed out and suggestions for the proper ways of co-operation in the establishment of proper psychiatric and psychosomatic diagnosis are presented.

Consultation-liaison in the renal transplant unit at Hannover Medical School began in Summer, 1976, and has developed up to now, step by step, in a somewhat experimental way. We emphasize this experimental building-up way because, to the best of our knowledge, there has not existed up to now a consultation-liaison unit which could serve as a model for us. Concerning the number of patients transplanted, initially, in 1975, 35 patients and in 1977, 100 patients underwent this procedure which was done by the Abdominal and Transplant-Surgery Department of our medical school. Our consultation-liaison activity was performed by our patient care, our regular conferences with participation of the nurses and psychosomaticist, and our teaching.