Bernhard Eikelmann

• Klinikum Karlsruhe

Day hospitals provide an organizational framework for complex psychiatric and psychotherapeutic treatments. They have been developed regarding treatment and in number, perhaps surprisingly, to fit existing standards in almost all domains of psychiatry. Similarities exist in the emphasis on acute treatment, in the orientation towards social inclusio...

Day hospitals provide an organizational framework for complex psychiatric and psychotherapeutic treatments. They have been developed regarding treatment and in number, perhaps surprisingly, to fit existing standards in almost all domains of psychiatry. Similarities exist in the emphasis on acute treatment, in the orientation towards social inclusio...

Malignant neuroleptic syndrome (MNS) is a rare side effect of antipsychotic medications but means a serious and life-threatening complication. The risk of MNS seems to be lower for second generation antipsychotics (SGA). We report the 9-month history of a 42-year-old female patient whose antipsychotic medication was switched to 800 mg per day of am...

Malignant neuroleptic syndrome (MNS) is a rare side effect of antipsychotic medications but means a serious and life-threatening complication. The risk of MNS seems to be lower for second generation antipsychotics (SGA). We report the 9-month history of a 42-year-old female patient whose antipsychotic medication was switched to 800 mg per day of am...

Hyponatraemias are well-known as side effects of psychopharmacological therapies, particularly occurring under the anticonvulsive compounds carbamazepin and oxcarbazepine. Lowered sodium levels in the context of the application of SSRIs can be seen as a consequence of the syndrome of inadequate ADH secretion (SIADH). We report on a 78-year old depr...

There are no valid data on the social exclusion of mentally ill people in Germany. This study analyses the social exclusion of the mentally ill. With a Scientific Use File on early retirement in 2003, we found a nationally representative database for chronically ill persons. The inclusion in the working market, the work income and the exclusion of...

Ziel der Studie: Über den sozialen Ausschluss psychisch Kranker gibt es in Deutschland keine zuverlässigen empirischen Daten. Die Studie unternimmt erste Analysen zur sozialen Exklusion dieser Personengruppe. Methode: Auf der Basis eines Scientific Use Files zur Frühberentung im Jahr 2003 wird eine für Deutschland repräsentative Stichprobe chronisc...

In the last decade between 1991 and 2001 the development and use of the psychiatric and psychotherapeutic care system in Germany has grown enormously, especially regarding earlier times in the patients ' view most problematic hospital treatment episodes. In 2001 more than 800 000 patients were treated in psychiatric and psychotherapeutic hospitals,...

Zusammenfassung Die Inanspruchnahme psychiatrischer und psychotherapeutischer Leistungen hat in der letzten Dekade erheblich zugenommen, am besten zu erkennen an der früher aus der Sicht der Patienten hoch problematischen Leistung „stationär psychiatrische Behandlung”. Im Jahr 2001 wurden mehr als 800 000 Patienten stationär behandelt, das entspric...

The social implications and disabilities of long-term mental disorders have been well described and are known for a long time. The classical paradigm of social psychiatry postulating that dehospitalization automatically generates social integration has proven to be wrong. Along that line the view that living in the community supported by different...

Lange schon sind die sozialen Nachteile und Behinderungen bekannt, auch vielfach beschrieben, welche mit chronischer psychischer Krankheit einhergehen. Die klassische sozialpsychiatrische Hypothese, dass soziale Integration automatisch durch Enthospitalisierung geschehe, hat sich ebenso wie die Auffassung überlebt, dass ein Leben in der Gemeinde un...

The social implications and long term consequences of mental disorders regarding sick days at work, unemployment rates and early retirement are considerable. Outcome in psychiatric treatment should be measured not only by reduction of psychopathological symptoms and improvement of subjective well-being respectively quality of life but also by takin...

Die sozialen Folgen psychischer Erkrankungen in Bezug auf krankheitsbedingte Fehltage, Arbeitslosigkeit und Frühverrentung sind erheblich. Der Erfolg psychiatrischer Therapie und Rehabilitation muss neben der Reduktion der psychischen Symptomatik, der Verbesserung des subjektiven Befindens und der Lebensqualität auch an bestimmten Maßen der soziale...

The aim of this study was to analyse whether the SF-36 questionnaire is a useful tool to evaluate the treatment outcome of a drug detoxification program. A pre post assessment of consecutive referrals to a drug detoxification program of a psychiatric state hospital in north-western Germany was conducted. Seventy-nine males and twenty-one females wi...

Ziel dieser multizentrischen prospektiven Studie war es, die Anwendung von Risperidon (n=37) und Clozapin (n=27) bei therapieresistenten schizophrenen Patienten in der täglichen Praxis psychiatrischer Krankenhäuser unter standardisierten Bedingungen zu beobachten und dabei insbesondere das subjektive Erleben der Patienten zu berücksichtigen. Sowohl...

Deinstitutionalisation is a complex process that in the past was often misunderstood solely as a run down or even closure of psychiatric hospitals. Although chronically mentally ill patients were prevented from long term hospitalisation some fundamental mistakes were repeated often: patients were simply discharged without any preparations and outpa...

This paper aims at assessing the vocational integration attained after a 3-year period by psychiatric patients who participated in different vocational rehabilitation programmes. In the north-western German region of Westphalia-Lippe a naturalistic follow-up study was carried out on 471 patients from three different types of vocational rehabilitati...

A combination of 4 so-called markers of alcoholism, i.e. methanol, acetone + 2-propanol, gamma-glutamyltransferase and carbohydrate deficient transferrin, was investigated in 341 blood samples from alcoholics and non-alcoholics. From the history of alcohol consumption, four defined subgroups were formed: non-alcoholics divided into (A) 33 persons w...

This study examines the objective and the subjectively reported state of health, the social network and the utilisation of mental health services in a representative group of homeless men (n = 50) at time of admission to a psychiatric hospital and compares these results with a control group (matched by diagnosis) of non-homeless men. The BPRS, the...

This study examines the objective and the subjectively reported state of health in a regional representative sample of homeless men (n = 50) at time of admission into a psychiatric hospital and shortly before discharge and compares the results with a control group (matched by diagnosis) of non-homeless men. The BPRS and the SF-12 Health survey were...

Objective: This study examines the objective and the subjectively reported state of health, the social network and the utilisation of mental health services in a representative group of homeless men (n = 50) at time of admission to a psychiatric hospital and compares these results with a control group (matched by diagnosis) of non-homeless men. Met...

Objective: This study examines the objective and the subjectively reported state of health in a regional representative sample of homeless men (n = 50) at time of admission into a psychiatric hospital and shortly before discharge and compares the results with a control group (matched by diagnosis) of non-homeless men. Method and Patients: The BPRS...

Vocational integration of mentally ill patients is confronted not only with illness-related restrictions but also with the current situation on the labour market and prejudices on the part of potential employers. The Consultancy Centres for Vocational Integration work with a supported employment approach which was adapted to the German situation. I...

More than twenty years ago, George Engel postulated the biopsychosocial model to take psychosocial factors into account concerning etiology and therapy of illness. In psychiatry, this model was particularly appreciated because of the apparent significance of psychosocial factors. This article evaluates theoretically whether the original biopsychoso...

There are about 200,000 homeless persons in Germany, 35,000 of them living on the streets. They suffer from unemployment, poverty, social isolation and physical impairments. More than two-thirds of them suffer from mental illness as well. Substance abuse predominates, but also schizophrenic and affective disorders and personality disorders show a h...

In Deutschland gibt es etwa 200 000 alleinstehende Wohnungslose, von denen ca. 35 000 direkt auf der Straße leben, ihre Situation ist gekennzeichnet durch Arbeitslosigkeit, Armut, soziale Isolation sowie erhöhte Morbidität. Mehr als zwei Drittel der Wohnungslosen leiden unter einer psychischen Erkrankung. Suchterkrankungen dominieren, aber auch Psy...

In recent years, economic pressure on extended and repeated psychiatric hospitalisation have increased dramatically. At the same time, diagnostic approaches, e.g., the new concept of the "young adult chronic patient" have improved. The first part of this article summarises reports and experiences on the chronic mentally ill and the so-called "heavy...

Der ökonomische Druck auf stationäre psychiatrische Behandlungen, die entweder lange andauern oder sich in rascher Folge wiederholen, hat in den letzten Jahren enorm zugenommen. Gleichzeitig haben sich die Möglichkeiten der Diagnostik durch neue Konzepte wie z. B. dem des ,,young adult chronic patient" verbessert. Im ersten Teil dieses Artikels wer...

Vocational rehabilitation of mentally ill patients is now focused outside the psychiatric hospital. Three types of programmes play a major role: outpatient work therapy programmes at psychiatric hospitals, jobs in (partly) sheltered employment facilities as in companies specially adapted for employing mentally ill persons, and workshops for the men...

Within the framework of a study on vocational rehabilitation of the mentally ill, we examined 83 schizophrenic outpatients enrolled in a work therapy program. The course of illness and rehabilitation was documented over a 3-year period by means of annual follow-up examinations. The sample comprised 44 men and 39 women with an average age of 35 year...

Within the framework of a study on vocational rehabilitation of the mentally ill, we examined 83 schizophrenic outpatients enrolled in a work therapy program. The course of illness and rehabilitation was documented over a 3-year period by means of annual follow-up examinations. The sample comprised 44 men and 39 women with an average age of 35 year...

Vocational rehabilitation of mentally ill patients is now focused outside the psychiatric hospital. Three types of programmes play a major role: outpatient work therapy programmes at psychiatric hospitals, jobs in (partly) sheltered employment facilities as in companies specially adapted for employing mentally ill persons, and workshops for the men...

The rehabilitation of mentally ill undergraduates is a neglected area. The scope and relevance of this problem are confirmed by the epidemiological figures available. A programme aimed at supporting mentally ill undergraduates at Münster university offers such students psychoeducationally oriented group therapy and intensive individual counselling....

Recently, American authors pronounced the hypothesis that Clozapine-response may be considered as a predictor of response to atypical neuroleptic. We report the history of a schizoaffektive patient unresponsive to butyrophenone and phenothiazine neuroleptic who was first treated with Clozapine and then with Risperidone and who reacted very differen...

All 52 regular users of a shelter in a medium-sized German city underwent a baseline psychiatric examination in 1990. Mental disorders, especially alcohol addiction and schizophrenic disorders, were recorded among 40 (77%). After four years the residential situation and the number and duration of psychiatric hospitalisations was recorded for 42 of...

Recently, American authors pronounced the hypothesis that Clozapine-response may be considered as a predictor of response to atypical neuroleptic. We report the history of a schizoaffektive patient unresponsive to butyrophenone and phenothiazine neuroleptic who was first treated with Clozapine and then with Risperidone and who reacted very differen...

Work therapy is a widespread form of sociotherapy. In contrast to pharmacological and somatic forms of treatment, proof of efficacy is difficult to produce in multimodal therapy of schizophrenic patients on account of the many methodological problems involved. Within the framework of an extensive study on the vocational rehabilitation of mentally i...

Since the early days in the 19th century, psychiatry has been dealing with chronic courses of illness and mental disabilities. The 1975 German "Psychiatry Enquete Report" has played a major role in achieving progress in the care system, allowing mentally ill patients with impending or established handicaps to be rehabilitated or to have long-term c...

Within the framework of a 4-year prospective study on the course and efficiency of vocational rehabilitation of psychiatric patients, 657 rehabilitants forming a representative sample underwent psychiatric examination and were questioned on their living and working circumstances. They are working in various institutions in Germany which offer vocat...

Work is an indispensable component in the treatment of (chronically) mentally ill patients. In critically scientific terms, however, there is no adequate proof of its therapeutic effectiveness. Efforts at evaluation fail because of the complexity of the clinical reality. Moreover, the differential aspects of the indication have been ignored in rese...

In Germany, the vocational rehabilitation of chronically mentally ill people is concentrated on the sheltered labour market, supplemented by special programmes for the care and reintegration of mentally ill people on the open labour market. Our investigation covered 502 representatively selected patients in sheltered employment (outpatient work the...

Presented are the findings of a 5-year prospective study concerning residential rehabilitation of 53 subjects with chronic mental illness living in a differentiated system of complementary facilities and services. The focus had been the chronically ill patients' development and disease course, as reflected in their psychological wellbeing, work sta...

In Germany, the vocational rehabilitation of chronically mentally ill people is concentrated on the sheltered labour market, supplemented by special programmes for the care and reintegration of mentally ill people on the open labour market. Our investigation covered 502 representatively selected patients in sheltered employment (outpatient work the...

The number of patients suffering from chronic mental disorders but living outside the psychiatric hospital is undergoing a steady increase, which is reflected in an increasing demand for appropriate vocational and occupational facilities. This demand is met primarily by outpatient work therapy, self-help enterprises and enterprises providing jobs t...

Psychiatric day hospitals are a relatively young therapeutic facility insufficiently known to many psychiatrists. This accounts for the application potential of day treatment not being adequately recognised and utilised despite its many advantages (efficacy, flexibility, versatility). Treatment at a day hospital is not a (more or less) acceptable a...

Psychiatric day hospitals are a relatively young therapeutic facility insufficiently known to many psychiatrists. This accounts for the application potential of day treatment not being adequately recognised and utilised despite ist many advantages (efficacy, flexibility, versatility). Treatment at a day hospital is not a (more or less) acceptable a...

Work ranks high in the rehabilitation of the mentally ill. Currently sheltered employment is often the only alternative to unemployment. We present a sample of 121 patients working at various facilities for vocational rehabilitation. All of these patients are chronically mentally ill, 77% of them suffering from schizophrenic disorders. With respect...

A 4-year prospective study was carried out on 53 chronically mentally ill patients living in a differentiated complementary residential complex. Our main question was how the lives of these patients develop, as reflected in their psychological wellbeing, working capacity, therapeutic requirements and any necessary periods of rehospitalization. At t...

The number of persons suffering from chronic mental disease but living outside the psychiatric hospital in the community, is rising, resulting in an increasing demand for facilities for occupation, occupational therapy and rehabilitation and for paid employment. The past few years have seen a distinct increase in the number of sheltered workplaces...

The complementary psychiatric (home) area is a relatively new branch of institutional psychiatry, the therapeutic evaluation and integration of which into everyday psychiatric thinking and acting has not yet become a reality. The evaluative study presented here covered 53 inmates and concerned their everyday life, the success of the treatment, pred...

What are the effects of the abrupt discontinuation of neuroleptics (suspension therapy) in acutely schizophrenic patients with unsatisfactory remission under standard neuroleptic therapy? This question was investigated in a prospective study of 159 patients. In addition to the psychopathologic results of the AMDP system, the self rating (VAMS) and...

More and more chronic mental patients live in the communities and are jobless. Most of them cannot be expected to become gainfully employed in the near future, but the aim of all efforts should always be a permanent working place or at least meaningful activity. Due to the multitude of institutions participating in rehabilitation work the only chan...