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J Vollmann

Publications and source records attributed to J Vollmann.

16 recordsLinked to original sources
PubMed1997

[Medical and ethical problems in the classification of psychiatric disorders. The "Wurzburger Schlussels" of 1933].

In 1930 a new classification of mental disorders, later on known as "Würzburger Schlüssel", was developed and tested for two years. It replaced the "Reichsirrenstatistik" from 1901, and included new disease entities. This pragmatical classification was mainly descriptive including a few elements regarding aetiology and course of disease. The "Würzburger Schlüssel" put emphasis on addictions (especially alcoholism), psychopathy (in teenagers as well as in adults) and on the sequelae of syphilis. However, most of the diseases in elderly patients were not classified as being due to the various descriptive disease entities, but to the age related category. The fundamental problems of the development and practice of a classification of psychic disorders and the accompanying medical and ethical problems, which are still important today, are discussed.

Adult↗
PubMed1997

Sleep deprivation combined with consecutive sleep phase advance as a fast-acting therapy in depression: an open pilot trial in medicated and unmedicated patients.

OBJECTIVE: The authors' goal was to test the hypothesis that the antidepressant effect of total sleep deprivation can be maintained by initially avoiding sleep during a supposedly "critical" time period in the early morning. METHOD: They studied 33 inpatients with major depression, melancholic type, all of whom responded positively to total sleep deprivation. Twelve of the patients were men and 21 were women; their mean age was 46.7 years (SD = 13.7). After total sleep deprivation, the patients started a sleep schedule from 5:00 p.m. to 12:00 midnight, which then was shifted back by 1 hour each day until a sleep time of 11:00 p.m. to 6:00 a.m. was reached. RESULTS: Twenty (61%) of the 33 patients who responded to total sleep deprivation with an improved state of mood maintained this improvement during sleep phase advance therapy. Drug-free and medicated patients did not differ from each other. CONCLUSIONS: The rapid amelioration of mood observed with total sleep deprivation can be preserved with a succeeding phase shift of the sleep period.

Antidepressive Agents↗
PubMed1997

[Self determination of patients in social psychiatric practice. A medical ethics model and its practical application].

To protect patients' autonomy, valid informed consent must be given prior to medical treatment. This includes disclosure of information, understanding, ability to decide freely, and competence/capacity of the patient. However, a psychiatric disorder may disturb the ability to make a choice of their own. These patients have lost their competence to give valid informed consent. In everyday practice of social psychiatry, it is of particular interest to have objective and valid criteria to identify the incompetent patient. These problems are discussed in a case report, and four criteria (understanding, reasoning, decision making and appreciation of the disorder) are presented to diagnose the patients' competence.

Adult↗
PubMed1996

Informed consent in human experimentation before the Nuremberg code.

The issue of ethics with respect to medical experimentation in Germany during the 1930s and 1940s was crucial at the Nuremberg trials and related trials of doctors and public health officials. Those involved in horrible crimes attempted to excuse themselves by arguing that there were no explicit rules governing medical research on human beings in Germany during the period and that research practices in Germany were not different from those in allied countries. In this context the Nuremberg code of 1947 is generally regarded as the first document to set out ethical regulations in human experimentation based on informed consent. New research, however, indicates that ethical issues of informed consent in guidelines for human experimentation were recognised as early as the nineteenth century. These guidelines shed light on the still contentious issue of when the concepts of autonomy, informed consent, and therapeutic and non-therapeutic research first emerged. This issue assumes renewed importance in the context of current attempts to assess liability and responsibility for the abuse of people in various experiments conducted since the second world war in the United States, Canada, Russia, and other nations.

Codes of Ethics↗
PubMed1996

["Informed consent" by the patient for publication of case reports. New guidelines by the "International Committee of Medical Journal Editors" (Vancouver Group)].

The "International Committee of Medical Journal Editors" has revised its guidelines regarding the protection of patients' rights to privacy in manuscripts submitted to biomedical journals. Information that might identify patients should not be published unless it is essential for scientific purposes and the patient has given written informed consent for publication after having been shown the manuscript to be published. This article discusses the new guidelines in the clinical context of psychiatry and psychotherapy. The ethical and legal problems raised concern (1) the informed consent process, (2) the content of scientific work and (3) the problem of third party consent (e.g. legal guardians).

British Columbia↗
PubMed1996

[Responsibility for the individual or the whole? Ethical considerations on medical responsibility].

Physician's patients are often faced with a conflict of interests between the benefit and other interests (society, institutions). This problem has emerged in medical history since the 18th century when the traditional loyalty towards the individual patient was challenged by a social orientations in the physician's ethos. Current bioethical theories regarding this professional conflict of interest are discussed and applied to allocation problems in HMO-health plans. It is argued that the conflict of interests can only be solved if doctors set their professional priority on the healing relationship towards the individual patient.

Conflict of Interest↗
PubMed1995

[Treatment of depression with sleep deprivation and sleep phase advancement].

Total sleep deprivation (TSD) exerts beneficial but only transient effects on mood in approximately 60% of the patients with a major depressive disorder (MDD). The positive effect of TSD is generally reversed after the next night of sleep. A pilot study of our group indicated that a consecutive one week phase advance of the sleep phase stabilized mood in more than half of the patients who responded to TSD. However, the majority of patients in our pilot study had been treated concomitantly with antidepressive medication. To exclude a possible synergistic effect of simultaneous antidepressive medication and the sleep-wake manipulation in the present study eleven medicated and sixteen drug-free depressed patients were investigated. In two thirds of the patients relapse into depression after successful TSD could be prevented. This effect seemed to be independent of adjunct antidepressant pharmacotherapy. Ten of these patients were studied polysomnographically prior to and during the treatment. Data analysis revealed that during the advance of the sleep phase no prolonged partial sleep deprivation took place. At the end of the study REM % had even increased and REM latency was still short in spite of clinical improvement, thus contradicting the assumption that REM sleep suppression is a necessary prerequisite for antidepressive therapy. The results support the hypothesis of a "critical phase" in the morning hours during which sleep can reinduce depressive mood and, vice versa, prevention of sleep during this time may act antidepressively.

Adult↗
PubMed1995

[Psychogenic paralysis of the arm after stereotactic brain biopsy].

A 45-year-old Turkish woman with a psychiatric history of depression and somatic disorder underwent an unnecessary stereotactic brain biopsy. After the procedure she developed severe palsy in the arm on the side of the operation without any somatic pathology. An integrative psychosomatic treatment approach focusing on the somatic problem improved the paralysis. Diagnostic and therapeutic issues in this case are discussed critically with reference to the literature.

Arm↗
PubMed1995

[Chronotherapeutic approaches in depressive disorders].

Sleep deprivation has been regarded as a beneficial treatment modality for about 60% of patients with Major Depressive Disorder. Unfortunately, however, more than 80% of the improved patients relapse into depression after the next night of sleep. In the present study we tried to prevent relapses into depression after successful total sleep deprivation (TSD) by treating 27 patients suffering from a Major Depressive Disorder according to DSM-III-R with a combination of sleep deprivation with consecutive sleep phase advance for 1 week. Advancing the sleep period to 5.00 p.m. until 12.00 p.m. following TSD and then gradually shifting back by 1 h daily the sleep period to the normal phase position (11.00 p.m. until 6.00 a.m.) prevented 61% of these patients from relapsing into depression. Thus, the combination of sleep deprivation with consecutive sleep phase advance has been proven to be an effective antidepressant treatment besides other well established antidepressive treatment modalities.

Adult↗
PubMed1992

[Biosocial relations as contact points in the social network. A contribution to the theoretical discussion in psychosomatic medicine].

Psychosomatic medicine needs a theoretical model for clinical tasks and for research. To start from Freud's psychoanalytic theory (conversion and anxiety neurosis) and Alexander's model of the "vegative neurosis" a system theory concept of the bio-psychosocial model (Lipowski) is presented and discussed critically. Instead of further investigation on the problem of "unity", or on monistic or dualistic views of the mind-body problem, we propose a new theoretical approach. If we focus our interest on nodal points of the bio-psychosocial network we can learn more about somatic-psychosocial interaction and can develop practical consequences for research and clinical issues.

Anxiety Disorders↗
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