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STUDY OBJECTIVE: A simple instrument to record case-related coercive measures was tested as part of a pilot project of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). METHODS: To assess coercive measures data were collected for 3 months in 8 German hospitals for psychiatry and psychotherapy. The type of measures used, the main diagnosis and the legal basis for the coercive measures were documented. RESULTS: In the sample studied, coercive measures were applied in 8% of cases. Coercive measures were most commonly used in patients with a schizophrenic disorder. The principle of justifiable necessity according to § 34 of the German Penal Code was used particularly often as the legal basis for justifying the coercive measures. CONCLUSION: Suitable measurement instruments and reliable data that enable the learning of best practices represent the basis for a reduction of coercive measures.

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Superficial cerebral hemosiderosis is characterized by sensorineural hearing loss, gait ataxia and pyramidal signs with irreversible myelopathy. It is caused by chronic hemorrhage into the subarachnoid space with hemosiderin deposition in the subpial, leptomeningeal and subependymal layers. Imaging of the entire neuroaxis is indicated to localize a source of bleeding, including cerebral and spinal angiography when necessary. Taking into account clinical signs and symptoms the interpretation of T2*-weighted images allows the radiologist to set the course for the optimal therapeutic regimen.

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An examination was made concerning doctors' and nursing staff's attitudes towards active euthanasia of patients suffering from coma vigil (2652 doctors and 5785 nursing staff were interviewed). This investigation made clear that most of the persons asked about this group of patients voted for a change in German laws following the Dutch example. There were noticeable differences observed between the professional groups. A majority (64.79%) were convinced that under certain circumstances it is justified to end intentionally the life of persons in a coma vigil. Of the nursing staff, 70.38% were in favour of this attitude, and 51.53% of the doctors share this opinion. Certain groups supported the question of active euthanasia more clearly than others. These were young participants in the investigation, first-time employees, nondenominational interviewees, those who are dissatisfied with their job situation, who are from the newly-formed German states, and who are divorced. The attitudes expressed by all these people originate in many different motives: thoughts about the patients, aspects concerning jobs, and personal aspects had an influence on results of the investigation. This single investigation which was restricted to patients suffering from coma vigil and to employees of the public health service, does not prove that the total population has generally changed its attitude toward active euthanasia. It is impossible to justify the necessity of new laws about euthanasia based on the above results.

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PURPOSE: Our study examines the frequency and further characteristics of psychiatric emergencies in the ambulance service of doctors on call in the city of Hamm. METHODS/PATIENTS: All emergency documentations of the year 2000 were retrospectively examined and evaluated with regard to psychiatric disorders according to the ICD-10. In Hamm (181, 197 inhabitants) there were 3812 emergency calls for doctors on call in the examined period. RESULTS: Due to internal emergencies, psychiatric diseases were diagnosed twice as often. Alcoholic intoxications (32.8 %), suicide attempts (16.8 %) and alcoholic withdrawal-syndromes were mostly diagnosed in psychiatric emergencies. Most patients were male. The average age was 41.7 years. CONCLUSIONS: In the education for doctors on call, the training in the subject psychiatry is very low. Therefore the education and training of the diagnostic and therapy of psychiatric disorders must be intensified in the acquiring of the certification for ambulance service. acquiring

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We report a case of an 18 year old female Turkish patient, who was suffering from psychogenic seizures. The family did not accept the disease, prohibited treatment by a medical doctor, preferred to bring her to a Hoca. She was maltreated by her father und sexually abused at the age of eight years by her brother. In this article we describe the problems of a psychiatric ill female patient within a family of Turkish origin.

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The phenomenon of patient homicides committed by health service employees has, in the previous years, repeatedly aroused much attention. The cases made known in Germany, the USA, Holland, Norway, and Austria appear to provide evidence to the effect that we are not only dealing with unique incidents. The scientific investigation of this especially sensitive taboo-topic is, to date, missing. The judicial trials carried out emphatically indicate that culprit motives, colleague behavior, but also to a large extent decisions made by superiors remain unclear. It remains controversial, what effect working conditions, strain of employees, their level of education and personal viewpoints over such criminal acts they possess. Finally, the long latency period between the first internal suspicions and the responsible parties' appropriate reactions requires duplicatable explanation. The following paper presents a German single-case study of patient homicide by a female nurse. The focus on causality rests on the presentation of developments up to the point where the long-fermenting suspicion could no longer be dismissed, and appropriate consequences took place. The account largely avoids the "definite" findings required during the judicial process. It concerns rather above all an open, uncertain, and possibly without external influence course of development which in stages each colleague in the health professions can trace, to the point where the uncertain and horrifying suspicion became a certainty. With this single-case study in hand it is made understandable in which ways personal circumstances and professional conditions at the worksituation can intertwine in such a way that the original motivation to help turns into its abysmal opposite. It is the author's intention to make preventive learning possible through this single case study. Every employee in the health professions should proceed on the assumption that such occurrences could also in his own field of work come to pass. In this respect, it is of considerable importance to differentiate between hasty and untenable incriminations and original increasing early-warning signs.

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A comprehensive analysis of the organization and personal setup was conducted at the Hans-Prinzhorn Clinic in Hemer, West Germany, from July to September 1989 after appropriate preparations that had taken about 12 months. The investigation method and the results are described. Besides the results themselves, planning and execution of this systematic study are significant in shaping the future development of this clinic. Later, and independent of our analysis, the Federal German Government promulgated a special regulation governing the setup of personal engaged in psychiatry, on 18 December 1990. The results of this regulation are compared with those obtained at our clinic. The results are practically always comparable or similar. Hence, minimum staff requirements in inpatient psychiatry were found to be near-identical as assessed by methodically different and independent analysis conducted at different times.

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