Objective Differences between patients with and without previous psychotic symptoms (PPS) in forensic addiction treatment under Section 64 StGB regarding clinical, functional, cognitive, and substance-related characteristics, as well as changes in their proportion between 2021 and 2025, were examined. Methods Data from 292 patients (259 without PPS, 33 with PPS) were analyzed. Results The proportion of patients with PPS increased significantly (OR=1.65; p<0.001). They showed lower functioning (35.24 vs. 44.37; p<0.001) and fewer months of imprisonment (29.8 vs. 49.4; p=0.003). Groups also differed in substance use disorders and criminal responsibility, but not in cognitive performance or social competence. Conclusions The findings suggest that patients with PPS show specific functional impairments that result in particular diagnostic and therapeutic requirements within forensic addiction treatment under Section 64 StGB.
Aim In Germany, abortion after 12 weeks is only permissible based on a medical indication. The study explores how physicians evaluate this indication in cases of psychological distress without foetal diagnoses. Method 17 semi-structured interviews with physicians were conducted and analysed using qualitative content analysis. Results Participants reported psychological distress due to unintended pregnancies in the context of mental illness, social difficulties, and sexualised violence. They described substantial legal and clinical uncertainties regarding the medical indication, as well as unclear responsibilities between gynaecology and psychiatry. Considerable access barriers were reported. Conclusion The findings suggest gaps in expertise and service provision for medical indications based on psychological distress. Closer collaboration between gynaecology and psychiatry, improved training and legal reforms appear necessary.
Ethics consultation in psychiatry helps to reflect on and resolve moral dilemmas, particularly where there is a conflict between patient autonomy and the professional duty of care. In the case of pregnant psychiatric patients, complex borderline situations often arise due to social instability, substance use disorders or mental health crises. Using two case studies - an ambivalent desire for a late-term termination of pregnancy and birth planning in the context of acute psychosis and the threat of compulsory admission - the text highlights the relevance of ethical case discussions. Ethics consultants play an important role in facilitating and mediating these discussions by promoting ethically sound and responsible decision-making through structured communication. In this way, ethics consultation can also help to reduce the moral distress experienced by healthcare professionals.
This qualitative study explores the role of "conceptions of normality" in the healthcare provision for autistic people. Fourteen individuals who identified themselves as autistic were interviewed using a problem-centered approach. The analysis was carried out inductively through thematic coding according to Flick. Our results showthat healthcare provision is limited by internalized rules related to care-specific structural conditions, the violation of reciprocal role expectations, and the lack of recognition of otherness. The interview partners employvari-ous strategies to conform to (anticipated) expectations of normality. This may result in care that does not adequately meet individual needs. The results show the role that (societal) assumptions of normality play in healthcare. Different patient groups can benefit from a design of healthcare that is characterized by an acceptance of diversity.
