[Sexual minorities between equality and exclusion].

The situation of people with different sexual orientations and gender identities varies worldwide depending on the legal and social situation despite a formal depathologization in the medical classification systems DSM 1973 and ICD 1991. The spectrum ranges from equality to discrimination and exclusion to social ostracism, sometimes combined with legal persecution, in some countries even with the threat of a death penalty. On the basis of a historical overview of the medical-social discourse, it will be shown which scientific and societal advances make depathologization possible, although even in today's times a consistent and sustainable effect of this depathologization appears to be increasingly difficult in some countries, and in some cases even a societal re-pathologization is taking place.

Sexual minorities between equality and exclusion.

The situation of people with different sexual orientations and gender identities varies worldwide depending on the legal and social situation despite a formal depathologization in the medical classification systems DSM 1973 and ICD 1991. The spectrum ranges from equality to discrimination and exclusion to social ostracism, sometimes combined with legal persecution, in some countries even with the threat of a death penalty. On the basis of a historical overview of the medical-social discourse, it will be shown which scientific and societal advances make depathologization possible, although even in today's times a consistent and sustainable effect of this depathologization appears to be increasingly difficult in some countries, and in some cases even a societal re-pathologization is taking place.

Ethical Aspects of Mental Health Care for Lesbian, Gay, Bi-, Pan-, Asexual, and Transgender People: A Case-based Approach.

The lives of lesbian, gay, bi-, pan-, asexual, and transgender (LGBTA+/LGBT) people are not considered to be standard in society, unlike those of heterosexual cisgender people. This can lead to prejudices against LGBT people and may negatively influence their access to high-quality health care. Medical and mental health care have been characterized by attitudes (psycho-)pathologizing LGBT lives and therefore supported the stigmatization of LGBT people in the service of heteronormativity.

[Effects and side effects of the disease concept "Homosexuality"].

The diagnosis of homosexuality was removed from the DSM in 1973 and from the ICD in 1991. Despite this formal depathologization, negative effects of the concept of "homosexuality" as a disease, which stems from the 19th century, are still evident to this day and will be highlighted in this article. Furthermore, we also demonstrate the related interactions between social and medical processes.

A need for orientation: The WMA statement on natural variations of human sexuality.

An alarming stigmatization and discrimination of homosexual people persists despite the formal depathologization of homosexuality, which occurred through the removal of the diagnosis from the DSM- (1973) and classification from the ICD (1991). The adoption of an expedited Statement on sexual orientation by the majority at the 64th General Assembly of the WMA is therefore an important and overdue measure. The Statement clearly asserts, among other things, that homosexuality is not an illness and therefore requires no cure.

[Pathogenetic and salutogenetic aspects of physicians' health].

Objective: To analyse pathogenetic and salutogenetic processes of physicians suffering from depression, burnout and drug addiction.

Methods: Qualitative follow-up interviews with 32 former physician patients from the Oberbergkliniken hospital group.

Results: Long working hours, bureaucratic restrictions and double burdens of combining family life and professional demands are major pathogenetic strains.

Course of life satisfaction in patients with depressive and addictive disorders after therapeutic intervention.

Background/aim: To analyse the course of life satisfaction during the clinic stay of patients with depressive and/or addictive disorders.

Methods: In a cohort study, 199 patients with depressive and addictive diseases were asked to complete a series of questionnaires at the start and the end of their psychotherapeutic treatment (on average 4.2 ± 2.

Cluster-randomized controlled trial of dissemination strategies of an online quality improvement programme for alcohol-related disorders.

Aims: This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany.

Methods: In a cluster-randomized controlled trial, 112 general practices were randomized into three groups. The first group (n = 43) received access to the online system and a training programme for the general practitioners (GPs).

Emotional and rational disease acceptance in patients with depression and alcohol addiction.

Background: The concept of a rational respectively emotional acceptance of disease is highly valued in the treatment of patients with depression or addiction. Due to the importance of this concept for the long-term course of disease, there is a strong interest to develop a tool to identify the levels and factors of acceptance. We thus intended to test an instrument designed to assess the level of positive psychological wellbeing and coping, particularly emotional disease acceptance and life satisfaction

Methods: In an anonymous cross-sectional survey enrolling 115 patients (51% female, 49% male; mean age 47.

Alcoholism in women: is it different in onset and outcome compared to men?

Onset and course of alcohol dependence show gender related differences (telescoping effect) suggesting that women are more vulnerable to chronic alcohol consumption. This raises the question whether the differences are associated with a different treatment outcome as well. We hypothesized, that alcohol dependent women with a telescoping course show a less favourable treatment outcome compared to men.

Detection and management of alcohol use disorders in German primary care influenced by non-clinical factors.

Aims: The primary objective was to assess the proportion of detected and correctly referred patients in German primary care. The secondary objective was to identify patient and practitioner characteristics that predict detection and correct referral.

Methods: In this clustered cross-sectional survey in German primary care, 3003 patients were consecutively invited to participate, and were asked to fill in a standardized health questionnaire.

DOVER and QUVER-new marker combinations to detect and monitor at-risk drinking.

Background: At-risk drinking is a common medical problem. "Objective" laboratory tests are widely used, especially in situations where it might be favorable for the patient to dissimulate the existing alcohol problem. In this study, we report a new approach to combine the biological markers % carbohydrate-deficient transferrin (%CDT) and gamma-glutamyltransferase (gammaGT) to increase diagnostic properties to identify patients with at-risk drinking behavior.

[Diagnostic and treatment approaches to alcohol-related disorders].

Background: Due to their high prevalence alcohol related disorders (dependent, harmful and at risk drinking) are of major importance for the general practitioner (GP). The aim of this study was to examine the diagnostic and treatment strategies employed by the general practitioners.

Methods: A standardized 10-page questionnaire was mailed to a representative sample (n = 1232) of the general practitioners in south-west Germany.

Galantamine: a cholinergic patch in the treatment of alcoholism: a randomized, placebo-controlled trial.

Objectives: The involvement of the central cholinergic system in alcohol abuse behavior is well known. It is possible that the reinforcing effects of ethanol are partially mediated by nicotinic receptors, which modulate neurotransmitter release. It was demonstrated that the application of a cholinesterase inhibitor reduces alcohol consumption in alcohol-preferring rats.

Neuroimaging of gender differences in alcohol dependence: are women more vulnerable?

Background: Alcoholic brain damage has been demonstrated in numerous studies using neuropathology and brain imaging techniques. However, gender differences were addressed only in a few studies. Recent research has shown that development, course, and consequences of alcohol dependence may differ between female and male patients.

Correlation of stable elevations in striatal mu-opioid receptor availability in detoxified alcoholic patients with alcohol craving: a positron emission tomography study using carbon 11-labeled carfentanil.

Background: The pleasant effects of food and alcohol intake are partially mediated by mu-opiate receptors in the ventral striatum, a central area of the brain reward system. Blockade of mu-opiate receptors with naltrexone reduces the relapse risk among some but not all alcoholic individuals.

Objective: To test the hypothesis that alcohol craving is pronounced among alcoholic individuals with a high availability of mu-opiate receptors in the brain reward system.

[The qualified-detoxification-of-alcoholics procedure--in light of the development of guidelines for the treatment of substance-related disorders].

The qualified-detoxification-of-alcoholics procedure encompasses the diagnosis and treatment of ethanol intoxication, the states of complicated and uncomplicated withdrawal, addiction as the underlying disease and the consequences of heavy drinking. There is empirical evidence that treatment periods of 3 weeks for inpatients are efficient and cost-effective and there are indications that the shorter treatment periods enforced by health insurance companies may lead to rapid relapse and readmission and hence to longer total treatment times and higher costs.

[Short- and medium-term outcome of outpatient treatment of alcohol dependent patients. A 6-, 18- and 36-month follow-up].

The aim of this study was to investigate the short- and medium-term outcome of alcohol dependent patients in Germany after a one-year outpatient treatment. For this purpose, a 6-, 18- and 36-month follow-up of 97 socially well adapted alcohol dependent patients treated between 1992 and 1997 at three "psychosocial advice center" run by the Diakonie Württemberg, Germany, was carried out. Based on the time period between treatment and follow-up, all 97 patients could be followed up for 6 months, 71 for 18 months, and 33 for 36 months.

Fetal alcohol syndrome: an international perspective.

This article represents the proceedings of a workshop at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Kenneth R. Warren and Faye J.

Neuroimaging in alcoholism: ethanol and brain damage.

This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The co-chairs were Karl Mann and Ingrid Agartz. The presentations were (1) Neuropathological changes in alcohol-related brain damage, by Clive Harper; (2) Regional brain volumes including the hippocampus and monoamine metabolites in alcohol dependence, by Ingrid Agartz, Susan Shoaf, Robert R, Rawlings, Reza Momenan, and Daniel W Hommer; (3) Diffusion tensor abnormalities in imaging of white matter alcoholism, by Adolf Pfefferbaum and Edith V.

Appetitve effects of drug cues modelled by pictures of the intake ritual: generality of cue-modulated startle examined with inpatient alcoholics.

Rationale: A cue-modulated startle test recently confirmed that smoking cues in smokers may not be withdrawal-like and aversive as traditionally believed.

Objective: Analogous tests were applied to alcohol cues in inpatient alcoholics.

Methods: Twenty-six withdrawn alcoholics (18 men) were examined.

Sex differences of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume in alcohol-dependent patients.

Background: Biological markers like carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and mean corpuscular volume (MCV) are used widely to screen for alcoholism. Most research has focused on male alcoholics, and there are few studies on female patients. The results are inconsistent; in general, they show lower sensitivities for all markers for women.