(K)ein Ende des Schreckens? Therapeutische Arbeit mit Familien von Opfern der NS-Euthanasie

In diesem Artikel wird der aktuelle Stand der Beforschung des Schicksals psychisch kranker Menschen an der psychiatrischen Abteilung des Klinikum Klagenfurt am Wörthersee während des Nationalsozialismus skizziert. Sterilisationen basierend auf dem Erbgesundheitsgesetz, Deportation und Tötung im Schloss Hartheim bei Linz, aber auch Transporte nach Klagenfurt und Tötungen in Krankenhausabteilungen sind dokumentiert. Der Autor beschreibt die diesbezügliche Tätigkeit der letzten Jahre analog zum Therapieansatz von traumatisierten Menschen: Sichern, Durcharbeiten und Wiederanknüpfen. Sichern des historischen Archivs, Sichern der bisherigen Forschungsergebnisse, Sichern der bisher gesetzten Zeichen, Durcharbeiten der Krankenakten, aber auch Begleitung der Familien, die Opfer zu beklagen haben. Das Vorgehen der rekonstruktiven Biographiearbeit gemeinsam mit Angehörigen zeigt, wie Trauerprozesse unter Berücksichtigung der transgenerationalen Weitergabe psychischer Strukturen von psychiatrischen Abteilungen aus proaktiv gestaltet werden können. Das Wiederanknüpfen wird repräsentiert durch Schritte in die Gegenwart und in die Zukunft: Aktuelle Forschungsprojekte und das Ringen um Entstigmatisierung und Schritte in eine Modernisierung der psychiatrischen Versorgungslandschaft in Kärnten runden das Thema ab.This article traces the current state of research concerning the treatment of mentally ill people within the psychiatric section of the Klinikum Klagenfurt am Wörthersee under the Nazi regime. It documents sterilizations based on the genetic-health law, deportations and killings at the Schloss Hartheim bei Linz, transports to Klagenfurt, and killings in hospital units. The author describes the recent research activities as analogous to the therapeutic work with traumatized patients: To save, to work through and to reconnect. To save the historic archives, the previous research findings, and acts of remembrance, to work through the medical records, but also to support the victim families. The experience with reconstructive biographical work with relatives shows how the psychiatric institutions can proactively create mourning processes while taking the trans-generational transmission of psychic structures into consideration. The reconnection is represented by steps in the present and the future: The article closes with an overview on recent research projects, the struggle to de-stigmatize the victims, and attempts to modernize the psychiatric care service in Kaernten

Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries

BackgroundThe COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that at its most extreme, this may manifest itself in increased suicide rates.MethodsWe sourced real-time suicide data from around the world via a systematic internet search and recourse to our networks and the published literature. We used interrupted time series analysis to model the trend in monthly suicides prior to COVID-19 in each country/area-within-country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic. Countries/areas-within countries contributed data from at least 1 January 2019 to 31 July 2020 and potentially from as far back as 1 January 2016 until as recently as 31 October 2020. We conducted a primary analysis in which we treated 1 April to 31 July 2020 as the COVID-19 period, and two sensitivity analyses in which we varied its start and end dates (for those countries/areas-within-countries with data beyond July 2020).OutcomesWe sourced data from 21 countries (high income [n=16], upper-middle income [n=5]; whole country [n=10], area(s)-within-the-country [n=11]). In general, there does not appear to have been a significant increase in suicides since the pandemic began in the countries for which we had data. In fact, in a number of countries/areas-within-countries there appears to have been a decrease.InterpretationThis is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. It offers a consistent picture, albeit from high- and upper-middle income countries, of suicide numbers largely remaining unchanged or declining in the early months of the pandemic. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic impacts of the pandemic unfold

Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness: A systematic review and meta-analysis

BackgroundAlthough people with serious mental illnesses have a high risk of contracting blood-borne viral infections, sexual health has largely been neglected by researchers and policy makers involved in mental health. Failure to address this shortcoming could increase morbidity and mortality as a result of undetected and untreated infection. We did a systematic review and meta-analysis to estimate the prevalence of blood-borne viral infection in people with serious mental illness.MethodWe searched the Cochrane Library, Medline, Embase, PsycInfo, CINAHL, and DARE for studies of the prevalence of HIV, hepatitis B virus, and hepatitis C virus in people with serious mental illness, published between Jan 1, 1980, and Jan 1, 2015. We group prevalence data by region and by virus and estimated pooled prevalence. We did a sensitivity analysis of the effect of study quality on prevalence.FindingsAfter removal of duplicates, we found 373 abstracts, 91 of which met our eligibility criteria. The prevalences of blood-borne viral infections in people with serious mental illness were higher than in the general population in places with low prevalence of blood-borne viruses, such as the USA and Europe, and on par with the general population in regions with high prevalence of blood-borne viruses (Africa for HIV and southeast Asia for hepatitis B virus and hepatitis C virus). Pooled prevalence of HIV in people with serious mental illness in the USA was 6·0% (95% CI 4·3–8·3). Sensitivity analysis showed that quality scores did not significantly affect prevalence.InterpretationPeople with serious mental illness are at risk of blood-borne viral infections. However, because of methodological limitations of the studies the prevalence might be overestimated. Serious mental illness is unlikely to be a sole risk factor and risk of blood-borne viral infection is probably multifactorial and associated with low socioeconomic status, drug and alcohol misuse, ethnic origin, and sex. Health providers should routinely discuss sexual health and risks for blood-borne viruses (including risks related to drug misuse) with people who have serious mental illness, as well as offering testing and treatment for those at risk

Der Kaspar-Hauser-Mythos | Psychoanalytisch orientierte Assoziationen auf den Spuren des rätselhaften Findlings

Die geheimnisvolle Biographie Kaspar Hausers fasziniert den Autor bereits seit Jahren. In den Monaten zwischen dem angekündigten Gen-Test des »Spiegels« zur Klärung der Identität Kaspar Hausers und dem mit Spannung erwarteten Ergebnis macht sich der Autor auf eine Reise auf den Spuren des rätselhaften Findlings, des potentiellen Erbprinzen von Baden. Ausgerüstet mit dem Werkzeug der Psychoanalyse stößt er bei der Identifkation mit Kaspar Hauser auf Irritationen, Ängste und Zweifel. In den spannenden und zugleich informativen Kapiteln präsentiert der Autor einen Be- und Verarbeitungsprozess dieser Gegenübertragungsgefühle

Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries

Background: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. Methods: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries’ ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms “suicide” and “cause of death”, before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). Findings: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72–0·91]); Alberta, Canada (0·80 [0·68–0·93]); British Columbia, Canada (0·76 [0·66–0·87]); Chile (0·85 [0·78–0·94]); Leipzig, Germany (0·49 [0·32–0·74]); Japan (0·94 [0·91–0·96]); New Zealand (0·79 [0·68–0·91]); South Korea (0·94 [0·92–0·97]); California, USA (0·90 [0·85–0·95]); Illinois (Cook County), USA (0·79 [0·67–0·93]); Texas (four counties), USA (0·82 [0·68–0·98]); and Ecuador (0·74 [0·67–0·82]). Interpretation: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold