Assessing the priority of human rights and mental health: the PHRAME approach.

Background: Protecting all human rights of people with mental health conditions is globally important. However, to facilitate practical implementation of rights, it is often necessary to decide which of these rights should be given priority, especially when they conflict with each other.

Aims: The aim of the Priorities of Human Rights and Mental Health (PHRAME) project is to develop a replicable approach to establish a proposed set of high-priority human rights of people with mental health conditions, to facilitate practical decision-making and implementation of such rights.

[Everyday transgressions of borderlines: the scandalization of clinical drug trials of the psychiatrist Roland Kuhn].

"Experimental case Münsterlingen: clinical trials in psychiatry, 1940-1980" is the name of the report of a control commission established by the government of the Swiss Canton Thurgau in 2016, after several articles in the press after 2012 had criticized the drug tests carried out by Roland Kuhn, the former clinical director of the cantonal mental hospital in Münsterlingen. The report discusses "fine discrepancies in everyday borderline transgressions" "from today's viewpoint". These borderline transgressions were seen especially in the missing, inadequate or undocumented informed consent of patients and in the usage of test substances, which varied between the (mostly) accepted or not refused intake and the camouflaged or (seldom) threatened application via injection.

[Ewen D. Cameron: interactions between a pioneering psychiatrist and his professional as well as societal contexts].

As early as in the 1930s the psychiatrist Ewen Cameron laid the organisational fundamentals for the reform of psychiatric hospitals, introduced the open-door system, and founded the worldwide first psychiatric day-hospital in 1946. He also developed an automated psychotherapy, called "psychic driving"; furthermore, he bundled the somatic treatments of his time (scientific context) to a new form of treatment that he called "depatterning". His public image initially was determined by his charismatic personality, which received important honors; e.

[Benefits and risks of psychiatric actions and the patient's right of self-determination].

The history of psychiatry shows that a right of self-determination of the mentally ill was widely unknown in the nineteenth century and became known in medicine through the juridical concept of informed consent as late as in the second half of the twentieth century. Since the beginning of the twenty-first century this human right has been increasingly recognized and respected in medical practice. This change of recognition is contributing to a change from a paternalistic to a participative medical attitude.

[Coercion in psychiatry: practical consequences of ethical aspects].

Within the framework of the legal and ethical requirements of the application of coercion in psychiatry, the perspective of its prevention is discussed. Coercion is permissible exclusively in cases of incapability of self-determination and immediate specific danger for the patient's physical integrity or life. Practical difficulties in assessing these criteria are illustrated by means of case examples.

[Impact of the Zeitgeist and human rights on psychiatric actions].

Background: Implementation of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). The idea of human rights developed during the era of the Enlightenment. This idea has been publicly discussed since the French Revolution of 1789 and its specification has been demanded politically.

[The role of psychopharmacotherapy in the development of social psychiatry in Germany].

Early experiences and indications are reported that psychopharmacotherapy, particularly as prophylactic long-term medication for prevention of relapses, has led to an increased recognition of social determinants of the course of illness, especially in schizophrenic patients. As a result, institutions combining both social and psychopharmacological treatment have developed, e. g.

[Research on humans suffering from dementia].

The urgent necessity for dementia research is justified by the prevalence and increase in dementia associated with the demographic changes, for which no causal treatment is available; however, during the progressive course dementia destroys the capacity for self-determination of persons affected and thereby an essential prerequisite for participation in research, i.e. a valid consent to a research intervention.

[Physicians conscience and Zeitgeist].

According to Luhmann conscience is understood as a value-neutral function for forming identity. Its background is biological in nature but receives its values from the normative context of family and society. In an evolutionary perspective group congruent behavior could offer a survival advantage that will be stabilized by an emotional bonding to a group.

[Ethics in psychiatric research].

This review presents the results of a book 1 on ethical problems of clinical research in psychiatry and its framework. The requirement of societally necessary research can be satisfied only if every research patient is appropriately protected against risks and burdens. A clinical research intervention is acceptable only if - its benefit-risk-relationship is reasonable and justified, and - the patient's informed consent is valid.

[Bonhoeffer's position on sterilization of the mentally ill].

Unlabelled: Karl Bonhoeffer was head of the psychiatric department of the Charité University Hospital from 1912 to 1938 and in 1923 expressed his expert opinion for the Prussian Provincial Health Council regarding the demand of the Saxon physician Gustav Boeters for the implementation of a sterilization law. Bonhoeffer wrote that eugenic sterilization cannot be successful because only obvious bearers of severe forms of mental illness can be registered but not the carriers of hereditary illness factors if they only lead to mildly expressed forms of illness or even if the carriers remain without symptoms. However, after the adoption of the "law for the prevention of offspring with hereditary diseases" in 1933 Bonhoeffer gave courses on hereditary health issues supporting the execution of the law.

[Psychopathology in the social context].

In his treatise "Allgemeine Psychopathologie"(1913) (general psychopathology), Karl Jaspers contrasted the avoidance of methodical one-sidedness, which today is described as being interdisciplinary, and the danger of making partial conceptions absolute. He argued in favor of the combined observation of the psychopathological phenomena of the "natural human being" to be analyzed and explained by scientific (and epidemiological) methods along with understanding the individual case study of the "cultural human being", which a person is as well, by using humanitarian hermeneutic methods. Because he discussed the social context only briefly, we will illustrate this in the following with specific examples: 1.

Different conceptions of mental illness: consequences for the association with patients.

Whenever partial knowledge is considered absolute and turned into ideological and dogmatic conceptions, the risk increases that the conditions for the people involved might become dangerous. This will be illustrated by casuistic examples of consequences of one-sided psychiatric conceptions such as social, biological, and psychological ideas about the treatment and care of the mentally ill. Present perspectives of an integrative model, i.

[Comments on language of psychiatrists and stigmatization of the mentally ill].

Language is determinative for psychiatric action, both for the understanding of the mentally ill and for treatment. More generally spoken, language also may be significant for the stigmatization of the mentally ill and of psychiatric institutions. Not least, language is the expression of the current social and cultural atmosphere, the zeitgeist.

Ethics of clinical research with mentally ill persons.

This article describes ethical, legal and professional components of the two core requirements of clinical research: informed consent and risk-benefit relationships. It deals particularly with the ethically relevant reasons, criteria, procedures and validity of (1) the informed consent process, (2) the relationship between benefits and risks, and as a requirement of its assessment: (3) standards and (quasi quantitative) criteria of benefits and risks and/or burdens of a research intervention. These requirements will be discussed with specific reference to research interventions in mentally ill patients, and particularly in those who are incompetent to consent.

Ethical issues in naturalistic versus controlled trials.

Ethical core issues in research with human subjects are related to informed consent and risk-benefit assessment. This is valid for all types of studies. However, there has been much greater focus of ethical considerations on controlled clinical trials than on naturalistic trials, probably because the former are interventional in nature and may have unknown and perhaps severe somatic risks, whereas naturalistic studies seem not to intervene but only to observe, and therefore are assumed to have fewer or almost no risks.

Ethical guidelines in psychiatric research.

Capacity to consent is a basic prerequisite for participation of patients as probands in research. However, mental illness often impairs this competence. Therefore, in psychiatric research, the first obligation is to assess a mentally ill patient's competence to consent.

Depression predicts mortality in the young old, but not in the oldest old: results from the Berlin Aging Study.

Objective: There is evidence that depression in old age is associated with an increased mortality risk, but studies have also yielded inconclusive results. Possible moderators of the depression-mortality association in old age discussed in the literature are differences in cardiovascular morbidity, effects of multimorbidity, and increasing effects of subthreshold depression symptoms, such as minor depression and loneliness, on mortality. This study is concerned with the depression-mortality association in old and very old age.

[Ethical questions in clinical research with the mentally ill].

The review deals with present problems of protecting mentally ill patients who are incompetent to give informed consent to participating in clinical research, and of assessment of the capacity to consent. 1. Clinical trials of drugs on efficacy and safety in incompetent patients are ethically justified and legally admissible if the investigational drug can be expected to exert a direct potential individual benefit and if such trials will be performed under defined criteria to protect these vulnerable patients.