Der Nervenarzt
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Case Reports
[Mental incapacity and incapacity to make a decision and their status for determining legal guardianship].
The juridical guidelines for legal capacity demand the distinction between continuous and temporary mental disorders. A case report illustrates the problematic nature of this distinction. In addition the parallels to legal requirements for guardianship are discussed.
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Complex regional pain syndromes (CRPS) occur as the inadequate response to painful trauma in a distal extremity. With CRPS I (sympathetic reflex dystrophy), no lesion of the nerve is present. Aside from sensory disturbances, burning deep spontaneous pain and mechanical allodynia are characteristic. ⋯ With slight spontaneous pain, a conservative therapeutic method may be applied (analgesics, rest, raised position). In case of insufficient improvement and in difficult cases, the effect of intervention (sympathetic blockade) should be tested and possibly a blockade series performed. After reduced spontaneous pain, physiotherapy should be increased stepwise.
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Case Reports
[New kinds of relationships on the internet. Virtual object relations in psychotherapy].
Communication in the internet by e-mail is gaining in significance in counseling and psychotherapy of suicidal patients as well as an additional communication in face-to-face psychotherapy. E-Mail contacts during psychodynamic psychotherapy are defined as a transference offer of a virtual object relation. In two case descriptions of suicidal patients, examples of making contact with psychotherapy on the internet are presented. The concept of the virtual object is explained and its application for understanding these initial scenes and phenomena is discussed.
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The question as to whether schizophrenics have an increased potential for delinquency and violent behavior has given rise to much controversy. During the past few years, a large number of epidemiological studies have demonstrated a moderate but reliable relation between schizophrenic disorders and violence. ⋯ The risk of delinquency and violent behavior was much higher in schizophrenics than in the general population. It is indicated, however, that mentally ill delinquents are only of minor importance within the overall group of offenders and that better preventive and therapeutic measures present opportunities for prevention.
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Electroconvulsive therapy (ECT) has antidepressive and antipsychotic effects. Since being introduced in Italy in 1938, its mode of action has still not been clarified. Treatment modalities have changed in many ways. ⋯ In therapy-resistant depression, for which the greatest number of data are available, the response rate lies between 50 and 60%. This has been confirmed by a descriptive analysis of all ECT treatments at the Department of Psychiatry, University of Vienna, between 1994 and 2000. There is a need for controlled studies on continuation therapy subsequent to successful ECT.