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Biomedical subjects

E Gollmer

Publications and source records attributed to E Gollmer.

9 recordsLinked to original sources
PubMed1999

[Experiences with the North Rhine-Westphalia PsyKG (mental health regulation) exemplified by the city of Münster].

The law on assistance and precautionary measures in cases of mental illnesses (PsychKG) for North Rhine Westphalia came into force on 1.1.1970. It replaced the "law on committal" of 1956. Thus the PsychKG of North Rhine Westphalia has been in force for more than twice as long as its predecessor which had been, as in other Federal states of Germany, a special part of the police regulations. The new North Rhine Westphalian provision of 1970 was the first to take the step towards a genuine law for mental patients (Saage/Göppinger 1994). It laid the foundations for a right of mental patients to assistance from their local authority--as a duty (section 3, section 5)--and already spelled out the principle of an assistance planned individually and focussed on the person. This principle is still in use today. While the sections about committal have been replaced by a Federal law ("Law on voluntary jurisdiction", (FGG), section 70), the other parts on precautionary assistance, on care during committal and on after-care for mental patients are still in force. A legal review planned already ten years back was abandoned after two years of discussion, for two reasons: firstly, because the setting of standards of quality and equipment for the ambulant care, which had been called for by the providers of social-psychiatric services seemed impossible to finance. Secondly, it was decided to wait until other new laws would be enforced, such as the "Law on care" (1992) and the new North Rhine-Westphalian law on Public Health care services (1997). In his article, the author examines the practical experience in applying the PsychKG NW from the viewpoint of a socio-psychiatric service provided by the local authority, and of the co-ordination of psychiatric activities between such services. These perspectives survey the remarkable variety of possible courses of action for different local authorities on the basis of a unitary legal norm. The article also presents the basic ideas developed over the last ten years in the Association of Social-Psychiatric Services of North Rhine-Westphalia (of whose executive committee the author is a member) with regard to the reform and implementation of the PsychKG: the legal duty to ensure care for all mental patients according to their needs, to provide for their medical, mental (psychic) and social requirements in the sense of the WHO guidelines, the duty of all parties concerned to co-ordinate and co-operate, and the inclusion of modern principles (which had, however, been developed already 30 years ago) such as the priority of out-patient treatment over inpatient treatment in the further development of care-service structures.

Commitment of Persons with Psychiatric Disorders↗
PubMed1998

[Compulsory referral to institutionalised psychiatric care and its organizational structure].

Nation-wide German Counseling Review regarding psychiatry in 1975 yielded a reasonable reform of psychiatric care in Germany. Especially outpatient and complementary caring concepts promoted the integration of psychiatric patients in their communities. However, this development was paralled by an increase of involuntary hospitalisations in Northrine-Westphalia. Within ten years involuntary hospitalisations doubled in some communities. These findings contrast with recent concepts of a complex community psychiatry with improved caring according to humanitarian principles and those of non-violence. These specific settings must be taken into consideration in developing community psychiatry. The report presents the activity of the working group concerning community psychiatry in Northrine-Westphalia. During its annual meetings a standardised and valid documentation concerning hospitalisation procedures in the communities as a means of quality control was discussed repeatedly. Taking into consideration the data of this survey the complex mechanisms leading to an increase of involuntary hospitalisations becomes understandable. Health reporting on a community level on the topic of involuntary hospitalisations is an important tool for discussion of its complex psychosocial and administrative mechanisms. Discussion about standard procedures in psychiatric emergency care service will thus be enabled.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

Prevalence of Erythema migrans Borreliosis in blood donors.

European Erythema migrans Borreliosis and North American Lyme disease are closely related to syphilis. This implicates a potential risk of infection for blood recipients. Eighty-six of 3,157 blood donors tested showed IgG-antibodies against Borrelia Burgdorferi. From among 47 persons of this group who could be examined, clinical signs of diseased skin, joints or nervous system, not diagnosed before, were found or could be suspected in 13 cases. Since intrauterine transmission of Borrelia infection has been described, the inevitable question of whether this disease can also be transmitted as a result of blood transfusion becomes a major concern. As the pathogen can persist even in the presence of serum antibodies, it seems advisable to examine blood donors serologically, whenever Erythema migrans Borreliosis is suspected. Though further research is required to document a transfusion-transmitted Borrelia infection, infected persons should be treated to avoid serious or late manifestations.

Antibodies, Bacterial↗
PubMed1985

[Progressive Borrelia encephalomyelitis. Chronic manifestation of erythema chronicum migrans disease of the nervous system].

A 54-year-old housewife became ill with transient diplopia followed by facial paralysis, tremor of the right hand and a progressively worsening disturbance in gait. Four years after the first appearance of the disease bilateral hypacusia, paralysis of the right hypoglossal nerve, dysarthria, severe spastic tetraparesis with ataxia, urinary retention and an organically induced character change were present. Lumbar puncture fluid contained 51/mm3 lymphocytes and 1164 mg/dl protein. Immunoglobulin A, G and M, synthesised locally, could be detected in cisternal fluid. The serum had a high antibody titre against Ixodes ricinus-Borrelia antigen and the same antibodies, formed locally, were present in the lumbar fluid. The neurological deficiencies improved markedly under parenteral penicillin treatment and the antibody titre decreased. The detection of Borrelian antibodies, especially those synthesised locally in the CSF, enabled an aetiological diagnosis to be made in seven other patients aged 18-47 years in whom the disease had been present for 1 to 8 years. These patients likewise presented symptoms characteristic of a disseminated disease of the CNS, with spastic pareses and evidence in the spinal fluid of chronic inflammation and disruption of CSF barriers in particular. This progressive encephalomyelitis differs from the common and spontaneously healing meningo-polyneuritis (Garin-Bujadoux-Bannworth), the usual manifestation of erythema chronicum migrans of the nervous system, in its progressive nature, its invasion of the CNS and the possible long lasting severe damage when not specifically treated.

Adolescent↗
PubMedDate not supplied

[What are the contributions of social psychiatry services to psychiatric patient management? Results from a mid-size, psychiatrically well supplied city 1988 and 1989].

Every year 10-12.5% of the population are in need of psychiatric treatment. Statistical investigations lead us to believe that indeed only one-third of the mentally ill receive treatment. Above all, alcohol- or drug-induced dependence and geriatric illnesses are becoming increasingly prevalent. Patients of the Social Psychiatric Services of the city of Muenster (FRG) for the years 1988 and 1989 were examined for sociodemographic and diagnostic data, and the case histories documented. In 1988 1,019 in 1989 915 citizens were looked after. The treatment was concentrated on the severely mentally ill (22%), psychic geriatric patients (16%) and above all, chronic alcoholics (33%). The studies show that the patients are frequently lonely, have poor accommodation (app. one-third receive only welfare aid, one-third are pensioners) and exist on state hand-outs. App. one-tenth are either under care or guardianship. The peripatetic home visits (1988: 1,923, 1989: 1,512 home visits) are particularly helpful for persons who are immobile or reluctant to establish contacts, and for their relatives. Crisis intervention was necessary for 10% and commitment to institutional care for 6-8%. The Social Psychiatric Services are assuming an increasingly important function in the care of the chronic mentally ill, who--because of "dehospitalisation"--have no access to regular professional care.

Adolescent↗
PubMedDate not supplied

Sural nerve biopsy findings in leprosy: a qualitative and quantitative light and electron microscope study in 4 treated cases of the lepromatous spectrum.

Reports on biopsy findings in multifascicular nerves in lepromatous leprosy (LL) are rare and detailed morphometrical data are not available. In a case of early LL with normal electrodiagnostic findings in sural nerve, the present study revealed marked segmental de- and remyelination concomitant with the sequelae of considerable Wallerian degeneration of preferentially small myelinated fibers (MF) in spite of a normal number/nerve and density/mm2. Segmental de- and remyelination of several consecutive internodes in teased fibers suggests continuous bacterial spread via Schwann cells. In 2 more advanced LL-cases, nervous parenchyme was severely reduced, in a borderline lepromatous (BL) case obviously in part caused by cell infiltrates and granulomata. Distinct fascicle differences in MF-involvement were demonstrated by coefficients of variation of MF/mm2 and teased fiber preparations in LL, consistent with the hypothesis of initial focal spread of bacteria. Numbers and densities of endoneurial vessels were increased only in the later stages of LL. Enlargement of endoneurial area, due to different factors, was encountered except for the most severe LL-case with extensive endoneurial collagenization. Morphometric results were compared with those of other neuropathies. Intact and degenerating bacteria mostly in phagosomes of Schwann cells associated with unmyelinated axons and in macrophages were seen only in the early LL- and the BL-case. Sparse mononuclear cell infiltrates and small focal necrosis, present even in LL-cases, underline the complex pathogenesis of nerve fiber involvement.

Adult↗