Der Nervenarzt
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[The Erlangen examination. An alternative to multiple choice testing for German neurology students].
With the latest revision of the German Medical Licensing Regulation in 2002, educating faculties gained more freedom in the organisation and assessment of trainees. The Erlangen Neurological Exam Structured (ERNEST) is an alternative for assessing competency in clinical knowledge at the end of the neurological general education. The answers must be given in written, short essay format. ⋯ The ERNEST is a viable alternative form of assessment as compared to the conventional MC exam. The basic quantitative parameters of the assessment comply with the requirements of medical assessments. The students evaluated ERNEST as mainly positive.
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The principle of informed consent to invasive diagnostic or therapeutic procedures is not applicable in most patients suffering from consciousness disorders. As in other medical situations, German law assigns priority to the patient's autonomy and employs the concept of presumed will inferred from third-party (e.g. relatives) communications or deduced from a living will. While discussion concerning the validity of such advance directives is ongoing, their applicability needs to be checked carefully in every case. ⋯ In clinical practice, efforts to deduce the patient's will must relate to the urgency and invasiveness of the intended medical procedures. This paper describes the framework of current legal rules and important case decisions involved in the process of decision-making for patients unable to give informed consent. Any such decisions must be documented comprehensively in hospital records.
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Empirical data are lacking that answer the question of how sexual murderers detained in forensic mental hospitals can be differentiated from those sentenced to prison. Psychiatric court reports and national criminal records on sexual murderers detained in a forensic mental hospital (n=45) were compared with those of prisoners (n=89) regarding diagnostic, criminologic, and prognostic characteristics and criminal recidivism rates after detention. Sexual murderers detained in forensic mental hospitals were characterized by higher psychiatric morbidity and slightly higher risk of future sexual and nonsexual violence. They were released from incarceration less often than the prison inmates but did not show higher sexual or nonsexual violence recidivism rates than those from the prison group.
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Recent years have seen a rise in the prescription of strong opioids for chronic and even subthreshold forms of pain. Animal and human experiments and clinical observations have shown that, compared to placebos, chronic opioid administration results in not only tolerance to its analgesic effects but also in heightened pain sensitivity. ⋯ Patients on long-term opioids will often reject proposals to withdraw the drug. Important elements of treatment are patient education, empathy and unconditional acceptance by the patient, motivation enhancement and psychological support, collaboration with other prescribers and therapists, detoxification, measures to increase pain tolerance, encouragement of general health behavior and salutotherapy, treatment of the primary illness, and prescription of participation oriented alternative analgesics.
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Comparative Study
[Attention deficit hyperactivity disorder in adults. Benchmarking diagnosis using the Wender-Reimherr adult rating scale].
We report on a study comparing different systems for the diagnosis of attention deficit hyperactivity disorder (ADHD) in adulthood. Recruited for evaluation were 168 patients referred to our ADHD outpatient unit. We used the Diagnostic and Statistical Manual of Mental Disorders 4th edn. (DSM-IV), International Classification of Diseases 10th edn. (ICD-10), and Utah criteria for diagnostic assessment and the Wender Utah rating scale, ADHD Self Report (ADHD-SR), and Wender Reimherr Adult Attention Deficit Disorder Rating Scale as psychopathological assessment tools. ⋯ Of the patients 56% had ADHD diagnoses according to all three classification instruments. Examining the factor structure of the ADHD psychopathology represented by seven WRI and three ADHD-SR subscales, we found a two-factor solution explaining for 63% of the variance. Factor 1 was designated by impulsivity, affective lability, hyperactivity, and hot temper; factor 2 consisted of inattention, disorganisation, and overreactivity.