[Unwanted pregnancy. Life conditions of children born after refusal of therapeutic abortion on psychiartric grounds (author's transl)].
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Biomedical subjects
Publications and source records attributed to H Kind.
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Fifteen patients (4 females and 11 males) with hypothalamo-hypopituitary dwarfism underwent extensive psychiatric investigation in 1962-1965. A follow-up study of the personality development and social conditions was made in 1977. The age of the patients ranged from 31 to 56 years (the average being 40). As before, the main finding was an infantile personality with a defective psychosexual maturity. Only a few patients had reached a somehat adult, independent personality in spite of hormonal deficiencies. Several patients had continued to grow and attained a stature slightly below average. However, this subsequent growth scarcely influenced personality development. Depressive moods are now more frequent than before and among the more differentiated patients, the neurotic symptoms are mainly phobic fears. Almost all of the patients have discontinued treatment with hormonal substitutes (androgenes, cortison, thyrotropic hormone) inspite of persistent deficiency symptoms, because the outcome did not match their high expectations. The symptoms of the endocrine psychosyndrome seem of minor importance compared with the psychic infantilism and the reactions to the experience of dwarfism and missing puberty. One female has suffered several psychotic episodes which were understood as being partially of endocrine origin.
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Twelve patients (8 females, 4 males) with panhypopituitarism who had been thoroughly examined psychiatrically in 1957 and 1958 were reexamined in 1974 for psychopathologic alterations in the course of their endocrine disease. Eleven patients had been receiving an adequate hormonal treatment during the intervening years or (four patients) until the time of their death. Seven patients showed a good or excellent result of hormonal therapy, in respect of the psychic symptoms: the endocrine psychosyndrome which had been observed prior to treatment had improved considerably. Signs of organic brain syndrome were judged to be caused by age and not by the endocrinopathy. The factors influencing prognosis of psychic symptoms are: alteration in mental activity, in the sense of apathy and lack of drive, and the extent of social distegration caused by these alterations; the age of the patient at the onset of symptoms and the lapse of time prior to the beginning of adequate therapy; finally the personality structure and the social situation of the patient.
Twelve patients with Cushing's syndrome (11 females, 1 male) who were examined for psychopathologic alterations in the course of the endocrine disease during the years 1960-61, were reexamined in 1976 regarding psychiatric sequelae after treatment. Ten patients had been treated by adrenalectomy, one patient by radiotherapy of the hypophysis, and one patient had refused any treatment. The average lapse of time from operation to reexamination or death (five patients) was 15 2/3 years. In seven patients it had been possible to stop completely the excessive production of adrenal hormones. Corresponding the long-term result was favorable, with complete recovery of the ability to work. The previous symptoms of the endocrine psychosyndrome disappeared almost completely. There was no permanent alteration of personality and the vital dependence on hormonal substitution was well tolerated. In four of the five patients with an unfavorable course of the disease it had not been possible to stop the excessive production of adrenal hormones. These patients became increasingly invalid and had to be cared for. Symptoms of chronic organic brain syndrome developed. In contrast to the course of panhypopituitarism where nonspecific personality factors are of considerable importance, in Cushing's syndrome the long-term prognosis depends entirely on the successful stoppage of the overproduction of adrenal hormones. The artificial subsitution is not necessarily a disadvantage for the psychic functioning of the patient.
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Computed tomography was used to find a sensitive parameter for bone mineralization. A precision scanning instrument was constructed for determination of the mineral distribution in sections of the forearm. The quality of the reconstructed images allows separate quantification of compact and spongy bone even when gamma rays are used. Computer simulation and measured of models and macerated human bones showed that under clinical conditions it is possible to quantify spongy bone density within an accuracy of +/-2%.
Two cases of malpractice in psychotherapy are described. In one case there was a psychiatrist involved, in the other a non-medical psychotherapist. The legal aspects of malpractice in the view of Swiss legislation are shortly discussed. A legal liability for damages caused by the psychotherapist might arise if the following conditions are fulfilled: A deviance from the generally accepted standards of care in psychotherapy, a damage to the patient as a consequence of this deviance and a negligence on the part of the psychotherapist. Furthermore, there has to be an adequate causal nexus between malpractice and damage done to the patient. By some case reports the author tries to exemplify what can be understood by the term of generally accepted standards of care in psychotherapy.
Modern warfare requires protection of the entire civilian population, and a main feature of Swiss planning is the provision of adequate shelter space for every inhabitant. The medical and psychologic problems of prolonged shelter living are considered, with reference to the literature on experience in other countries. The study centers on description of a shelter occupancy experiment. 25 men with an average age of 37 years spent 7 days in a closed shelter during the hottest part of the year. Floor space was 1.2 m2 and room volume 2.5 m3 per person. The experiment revealed that in-shelter climatic conditions remained tolerable. Initially several members of the group suffered from insomnia and nausea, while sleep disturbances, headache and gastrointestinal symptoms also occurred in the course of the stay. Daily self-rating of condition with appropriate scales showed a positive correlation of "irritability" with air humidity and a negative correlation of "vitality" with room temperature. Good shelter management and a trained leader are essential prerequisites for prolonged shelter occupancy.