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OBJECTIVE: The higher incidence of man-to-woman transsexuals compared to woman-to-man transsexuals varies markedly from country to country. This is the first survey of the sex ratio to be made in Germany. METHOD: It covers 1785 patients who between 1964 and 1998 were diagnosed as transsexual at the four largest German centres offering treatment. RESULTS: From 1970 to 1994 the sex ratio remained constant at 2:1 in favour of man-to-woman transsexuals. Over the past 4 years, however, it has altered considerably and reached 1.2:1. CONCLUSION: Up to 1994 our results do not support the assumption that transsexualism is gradually becoming equally prevalent in both sexes. The drop in the sex ratio after 1994 can be explained either as a reduction of an overhang of male-to-female transsexuals or as an artificial phenomenon caused by recent developments in therapy and by the views of transsexuals' groups on the treatment they are offered.

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Recently, the mutation causing early-onset generalized torsion dystonia has been identified as a GAG deletion in the gene for an adenosine triphosphate-binding protein named torsinA. We describe a German family with 5 clinically affected individuals carrying this mutation. In at least 4 of the 5 patients, the disease presented as a dystonic writer's cramp during late childhood or adolescence, which affected sequentially both sides but did not progress to a generalized form of dystonia. We conclude that familial writer's cramp may be a manifestation of the DYT1 mutation.

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187 general hospital patients were questioned in a prospective study with a semistructured interview about their subjective experience and assessment of the psychiatric consultation. Over 40% complained that they had been given insufficient information about the psychiatric consultation by their primary care physician. It was rarely (10%) found to be unpleasant, and 46% of the patients specifically stated that it had been valuable. In order to improve the efficiency of the psychiatric consultation more attention should be paid to the subjective judgement of the patients.

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Gender identity change in intersexual patients is rare. We report on the transsexual development of a patient with male pseudohermaphroditism. The case report emphasizes the importance of a thorough differential diagnosis.

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The frequency of galactorrhea and the subjective response to it were investigated in 150 schizophrenic patients. The incidence rate was 14% and the prevalence rate 19%. The latency periods between start of neuroleptic medication and manifestation of galactorrhea were subject to substantial scatter, as were the prolactin values. Patients who had undergone neuroleptic relapse prevention prior to the index episode and/or had been pregnant were affected significantly more frequently by galactorrhea.

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The frequency of galactorrhea and the subjective response to it were investigated in 150 schizophrenic patients. The incidence rate was 14% and the prevalence rate 19%. More than half the women experienced galactorrhea in connection with their femininity, with this side effect of neuroleptic therapy being rated more often as a positive effect, especially as a reinforcement of feminine identity or as an expression of the ability to conceive children. The overall response to galactorrhea was positive among 43% and negative among 20%, with the remaining patients tending towards indifference.

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Although the psychosexual development of patients with Klinefelter's syndrome is often delayed, the sexual identity is generally male. This paper reports on a 56-year-old patient whose initially good psychosocial integration gave way to a transsexual development with a meanwhile clearcut female sexual identity as the consequence of a personal crisis situation. This case report illustrates the interaction of biological and psychodynamic etiological factors.

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Sixty-one acute schizophrenic patients were questioned on the effects ascribed subjectively by them to their neuroleptic medication and on their rating of neuroleptic therapy. Although negative effects ascribed to the medication outnumbered positive effects by 3 to 1, the global rating was predominantly positive. Patients approving of neuroleptic therapy reported favourable changes under medication significantly more often than patients with a rejecting attitude. There was, however, no significant difference between the two groups in the frequency with which negatively experienced effects of medication were described.

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30 patients with writer's cramp were examined by a neurologist and a psychiatrist. The syndrome was frequently associated with a postural tremor. We found no evidence for a peripheral causation. Electromyographical recordings showed co-contractions of agonists and antagonists as well as individual patterns of increased muscle activity during writing. CT and MRI scans were normal in most patients. The psychiatric examination revealed a history of situational stress at the onset of the disease and also some abnormalities in the biography and personality traits. Since the latter findings were not consistently present we have no evidence that the disease is a neurotic manifestation. We consider it likely that secondary psychoreactive processes may have some significance in the individual patient.

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Although its aetiopathogenesis is still unknown, writer's cramp is meanwhile regarded essentially an organically induced disorder. However, as shown by this interdisciplinary study, psychodynamic factors should not be neglected. Special attention should be given to the patients' experience of the syndrome and secondary psychoreactive processes.

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