The creator of the term 'anancasm' was Hungarian: Guyla Donáth (1849-1944)

There is considerable confusion in the field of research on the history of psychiatry as to who created the term anancasm. This article seeks to clarify that the term was coined by the Hungarian psychiatrist Gyula Donáth, who was born in Baja, on the Danube, and worked mainly in Budapest. Donáth's publications reveal that his predominant sphere of interest and research was neurology and psychiatry. A number of his publications deal with epilepsy and obsessive-compulsive disorders. After a period of intensive research, during which he spent some time in Berlin at the clinic of neuroscientist Carl Westphal, Donáth proposed the term 'anancasm' in 1895 to describe compulsive mental processes.

Ernst Rüdin's Unpublished 1922-1925 Study "Inheritance of Manic-Depressive Insanity": Genetic Research Findings Subordinated to Eugenic Ideology

In the early 20th century, there were few therapeutic options for mental illness and asylum numbers were rising. This pessimistic outlook favoured the rise of the eugenics movement. Heredity was assumed to be the principal cause of mental illness. Politicians, scientists and clinicians in North America and Europe called for compulsory sterilisation of the mentally ill. Psychiatric genetic research aimed to prove a Mendelian mode of inheritance as a scientific justification for these measures. Ernst Rüdin's seminal 1916 epidemiological study on inheritance of dementia praecox featured large, systematically ascertained samples and statistical analyses. Rüdin's 1922-1925 study on the inheritance of "manic-depressive insanity" was completed in manuscript form, but never published. It failed to prove a pattern of Mendelian inheritance, counter to the tenets of eugenics of which Rüdin was a prominent proponent. It appears he withheld the study from publication, unable to reconcile this contradiction, thus subordinating his carefully derived scientific findings to his ideological preoccupations. Instead, Rüdin continued to promote prevention of assumed hereditary mental illnesses by prohibition of marriage or sterilisation and was influential in the introduction by the National Socialist regime of the 1933 "Law for the Prevention of Hereditarily Diseased Offspring" (Gesetz zur Verhütung erbkranken Nachwuchses).

Emil Kraepelin's ideas on transcultural psychiatry

OBJECTIVE

Prevailing degeneration theory and an increasing number of people in inpatient mental treatment aroused the famous German psychiatrist Emil Kraepelin's (1856-1926) interest to investigate whether the mental illnesses typical for Europe were also characteristic for 'primitive peoples'. He thus dedicated a period spent in the Dutch East Indies (Java) in 1904 to transcultural psychiatric research. This paper endeavours to compile Kraepelin's key findings, aiming to make readers aware of what kind of transcultural research Kraepelin did and what conclusions he came up with. At the same time it provides some background for the question of whether Kraepelin can really be referred to as the founder of transcultural psychiatry.

CONCLUSION

Kraepelin assumed that illnesses with exterior causes depended on the type of stimulants widely used in a given culture. Since he found little evidence for progressive paralysis, he concluded that European brains were particularly prone to sequelae of syphilis. For endogenous psychoses he postulated differences in both symptoms and courses, depressions being rarer and milder, and ceasing sooner. By contrast, he found dementia praecox (mainly covered by the concept of schizophrenias later) to be the most prevalent mental illness in Java, explicitly different in form from that in Europe.

[The contributions by Emil Kraepelin to the knowledge on sleep disorders and their treatment]

While Emil Kraepelin's comprehensive psychiatric oeuvre has attracted researchers' attention, his studies on sleep disorders and their treatment as well as on the interconnections between sleep and mental disorders so far seem to have been neglected.This article identifies and analyzes Kraepelin's sporadic contributions on the pathology of sleep, the comorbidities and treatment made between 1883 and 1924 in textbooks and isolated papers as well as in a presentation that was also published and compares them with current opinions in sleep research.Kraepelin never published a dedicated work on sleep, apart from a summary of the different narcotics; however, his occasional statements reveal astonishing insights and in particular his clear etiologically oriented classification of sleep disorders is captivating. Similar to the current classification, Kraepelin conceptualized sleep disorders as symptoms or rather a complex of symptoms and also identified associated diseases which once again are very near to current opinion. Apart from this his recommendations on sleep hygiene and, in a second step, pharmacological treatment of pathological sleep patterns are still clinically relevant. As early as the end of the nineteenth century Kraepelin laid down an algorithm of treatment which is very similar to the current clinical guidelines. At Kraepelin's time it seemed impossible to reach an agreement on classification and treatment issues of sleep disturbances and even though there has been an ongoing discussion until the present day, an agreement at least about guidelines could be reached. Against this background Kraepelin's contributions can still be regarded as a proposal for best practice.

["Even electricity cannot work wonders!". Neglected achievements by German psychiatrists around 1880 in the treatment of depressions and psychoses]

Parallel to the recent reneurobiologization of psychiatry as a subject, therapies based on electricity and elektrcomagnetism are returning to mental health care. Around 1880, the application of brain stimulating treatment on patients was particularly popular among German psychiatrists. This fact has largely been ignored in historical psychiatric research as present day practices, in particular deep brain stimulation (DBS), have frequently been seen solely within the tradition of brain surgery. Against this background the present study aims to revive the first trials of non-surgical electrical brain stimulation on depressive and psychotic patients, highlighting a 2-part study published by Wilhelm Tigges. It was Tigges along with Rudolph Gottfried Arndt and Wilhelm Erb who tried to establish clear rules on the most beneficial application methods and doses. Interestingly, Tigges's therapy was successful in cases of severe depression with chronification potential, i.e. precisely the clinical picture for which brain stimulation therapies are reserved today as a last option and ascribed an easing and even curing potential. Trigges also found that electricity produced almost no positive effect whatsoever with madly insane patients and hence anticipated the current non-application of DBS on these patients. After 1890 electrotherapeutic approaches in psychiatry were marginalized, first and foremost as no clear and reliable rules could be verified for their application, nor could their mode of action be fully explained. The success of electrotherapy in psychiatry was also restricted due to limitations of the time, namely (1) electrophysiology only emerging as a discipline, (2) the electrophysical medical apparatus industry only beginning to be established and (3) the lack of generally accepted guidelines and electrotherapy restriction to individual, barely generalizable experience (eclecticism). Present day applications of electricity, mainly DBS, have overcome these problems.

Angiofibroma in a cockatiel (Nymphicus hollandicus)

Human angiofibromas are rare and arise typically in the nasopharynx. In veterinary medicine they have only been described in the dog. Microscopically, angiofibromas consist of irregular groups of blood vessels within a stroma of connective tissue, with oedema and secondary inflammation often present. A cockatiel (Nymphicus hollandicus) was presented with an oral mass that consisted of aggregates of blood vessels surrounded by a connective tissue stroma, with the presence of oedema and secondary inflammation. Tumours of the oral cavity are uncommon in birds and to the authors' knowledge this is the first case of avian angiofibroma.

[Differential diagnosis of bipolar disorder: historical and clinical implications and perspectives]

In DSM-5, bipolar disorder (BS) is no longer conceptualised as a pure mood disorder together with unipolar depression, but as a bridge between schizophrenia and depressive disorders. This nosological classification is founded on the historical context of the 19th century. In addition to unipolar depression and schizophrenia, schizoaffective disorder, borderline personality disorder and attention-deficit hyperactivity disorder (ADHD) overlap with BS symptomatology. Overlap also exists with somatic diseases such as multiple sclerosis, Cushing's syndrome and syphilis as well as iatrogenic affective syndromes.

[The identity of medical psychology: a historical quest]

The starting point of this study is the current uncertainty in German-speaking medical psychology about its actual and very own natural area of expertise. The current study ventures to advance the hypothesis that part of this uncertainty is due to the fact that during the scientific area in its history (approx. 1850-1960) medical psychology abandoned its historical core competence as it emerged and developed during the age of enlightenment (end of 17(th)-18(th) centuries). To make this change clear, different examples of the 2 opposing conceptualisations of medical psychology are discussed, of course in a selected and maybe even provocative way. The change in concept also led to the fact that the interrelationships with and differentiation from its neighbouring disciplines are not clear and sharp either, since at times 2 or more disciplines declare themselves competent for one and the same thing. This is exemplified on the manifold overlappings with clinical psychology. Given the lack of resources now and in the future, this lack of a clear definition of competence might lead to continued uncertainty as well as to conflicts over distribution. On the other hand though, the look into the history of the subject reveals that at all times it has been a matter of individual approach or attitude as to what was regarded as core area of interest and competence of medical psychology and how far it overlapped with neighbouring disciplines. From the point of view of the history of psychiatry and on the basis of carefully selected historic material, this paper presents the core of 2 different concepts of medical psychology to elaborate this hypothesis.

Johann Christian August Heinroth on sleep deprivation as a therapeutic option for depressive disorders

Partial or total therapeutic sleep deprivation leads to an immediate and far-reaching release of depressive symptoms in about 60% of patients with depressive disturbances. It is for that reason that this therapeutic option is offered and studied in many psychiatric clinics. Several papers have acclaimed the German psychiatrist Johann Christian August Heinroth (1773-1843) - the first university professor of psychiatry--as a pioneer of this therapeutic approach. However, no reference has been made specifying where in his comprehensive oeuvre he promoted this notion, nor has any analysis of the texts or passages in question been delivered. This study demonstrates that Heinroth indeed understood the existence of numerous close bidirectional relationships between mental disorders and sleep, above all, disorders of the latter. Consequently, he explicitly recommended sleep deprivation as a therapy for "melancholia," the contemporary name for depressive disorders. This finding is of apparent relevance to the history of psychiatry and sleep medicine. One should nonetheless bear in mind that the passages summarized below are scattered throughout Heinroth's famous Textbook of Psychiatry of 1818 and other works, and that Heinroth never elaborated on this issue systematically. Moreover, his statements promote the impression that they were the result of vague impressions and thoughts, and that Heinroth did not benefit from extensive experience. Yet what is important to note is that he regarded sleep deprivation as a feasible treatment option only for patients whose depression had recently been diagnosed.

Efficacy and safety of initial combination treatment with sitagliptin and pioglitazone--a factorial study

AIM

To evaluate the efficacy and safety of initial combination therapy of sitagliptin 100 mg/day coadministered with all marketed doses of pioglitazone in patients with type 2 diabetes.

METHODS

Patients with A1c ≥7.5 and ≤11.0% were randomized among seven arms that received, once daily, 100 mg sitagliptin alone; 15, 30 or 45 mg pioglitazone alone, or 100 mg sitagliptin plus 15, 30 or 45 mg pioglitazone for 54 weeks. The primary endpoint was change from baseline in A1c at week 24. Protocol-specified analyses compared combination therapies with monotherapies at respective dose-strengths and combination of sitagliptin plus pioglitazone 30 mg with pioglitazone 45 mg monotherapy. Post-hoc analyses compared sitagliptin plus pioglitazone 15 mg with pioglitazone monotherapy at the two higher doses.

RESULTS

Initial combination therapy with sitagliptin and pioglitazone provided significantly greater reductions in A1c (0.4-0.7% differences) and other glycaemic endpoints than either monotherapy at the same doses. Combining sitagliptin with low-dose pioglitazone generally produced greater glycaemic improvements than higher doses of pioglitazone monotherapy (0.3-0.4% differences in A1c). Combination therapy was generally well tolerated; adverse events (AEs) of hypoglycaemia were reported with similar incidence (7.8-11.1%) in all treatment groups over the 54 weeks of study; oedema was reported in 0.5% of patients in the sitagliptin monotherapy group and 2.7-5.3% among pioglitazone-treated groups. Significant weight gain was observed in all combination-treated groups compared with the sitagliptin monotherapy group.

CONCLUSIONS

Initial combination therapy with sitagliptin and pioglitazone provided better glycaemic control than either monotherapy and was generally well tolerated.

[Research on Depression in the GDR - Historical Lines of Development and Therapeutic Approaches]

BACKGROUND

Historical research has raised the issue of whether GDR psychiatry was isolated from Western influences to such an extent that an autonomous East German psychiatry developed. Taking a chronological approach and being based on a clearly defined range of topics, the objective of this paper is to identify specific contributions made by GDR psychiatry to academic research as well as the degree of its international orientation by focusing on the treatment and research on depression.

METHODS

We have performed a systematic review of the East German psychiatric journal "Psychiatrie, Neurologie und medizinische Psychologie" and a screening of all psychiatric textbooks that appeared in the GDR.

RESULTS

Although East German psychiatry was oriented towards Soviet as well as Western developments, some internationally used therapeutic or conceptual innovations reached East German clinics only with some delay. Yet, East German psychiatrists have also contributed their own, independent nosological and therapeutic concepts to research on depression. Pivotal figures included, among others, R. Lemke (Jena), D. Müller-Hegemann (Leipzig) or K. Leonhard (Berlin).

CONCLUSION

With regard to research on depression one cannot truly speak of an autonomous East German psychiatry. Developments in East and West were largely running in parallel.

[On the history of obsessive compulsive disorders: their place in the nosological classifications up to the beginning of the 20th century]

Influenced by French psychiatry, the first German works on obsessive-compulsive phenomena were published in the second half of the 19th century. First they were seen as one form of the unitary psychosis, later they became involved in the dispute about the concept of paranoia. The first German definition, proposed by Carl Westphal in 1877 and of crucial importance in the conceptual history of obsessive disorders as an illness (OCD) ever since, stood in this tradition. Still the adequate nosological classification of obsessive phenomena was still heavily disputed. As more and more varied forms of obsessive disorders were described, the highly unspecific concept of neurasthenia gained importance. Then degeneration theory was a widespread aetiological concept to integrate the large number of obsessive phenomena. Towards the end of the 19th century, when psychoanalysis emerged, psychological aspects started to interest psychiatrists and psychoanalytical suggestions like Sigmund Freud's concept of obsessional neurosis were discussed. However, none of these different nosological suggestions, nor any of the proposed definitions, found general approval. Above all the question to what extent affects were involved and whether certain phenomena were compulsive in nature or not remained the subject of (ongoing) controversy. This led to a variety of highly inconsistent aetiopathogenetic concepts being proposed.

Richard Arwed Pfeifer - a pioneer of 'medical pedagogy' and an opponent of Paul Schroder

Richard Arwed Pfeifer (1877-1957) was one of the initiators and foster fathers of the renowned child-psychiatric and special needs education workgroup at Leipzig University under Paul Schröder (1873-1941) in the 1920s and 1930s. This paper is an account of their dispute concerning the interrelations between child and adolescent psychiatry and special needs education, as well as their disagreement about whether adolescent psychopaths should be admitted to specialized child psychiatric wards or elsewhere. Moreover, Pfeifer questioned the practical relevance of the separation of constitutional and environmentally-based psychopathy and fought eugenic research, which he found incompatible with the ethics of his profession as a remedial teacher and child psychiatrist.

[Karl Leonhard is "not interested!" - newly found original sources provide new insights into the organisational background of the Rodewisch propositions]

In 2013 at the Rodewisch Clinic for Psychiatry, four folders were found that contain original documents from the office of former head of the clinic Rolf Walther. These original sources provide new insights into the organisational background of the International Symposium on Psychiatric Rehabilitation of 1963, as a result of which the groundbreaking Rodewisch Propositions were framed. The documents founds reveal that, apart from the persons already identified, Halle/Saale - based hygienist Karlheinz Renker was deeply involved in the preparation of this event. They also show that for ideological reasons the GDR Ministry of Health restricted the number of participants from non-socialist countries, in particular Western Germany, to be admitted. Finally, the sources suggest that a volume compiling all talks given at the symposium as one publication and as such making its content and resolutions known to a wider public failed, among other reasons, due to the fact that Karl Leonhard, then head of the GDR Association for Psychiatry and Neurology, was "not interested" in it.

Observation of Floquet-Bloch states on the surface of a topological insulator

The unique electronic properties of the surface electrons in a topological insulator are protected by time-reversal symmetry. Circularly polarized light naturally breaks time-reversal symmetry, which may lead to an exotic surface quantum Hall state. Using time- and angle-resolved photoemission spectroscopy, we show that an intense ultrashort midinfrared pulse with energy below the bulk band gap hybridizes with the surface Dirac fermions of a topological insulator to form Floquet-Bloch bands. These photon-dressed surface bands exhibit polarization-dependent band gaps at avoided crossings. Circularly polarized photons induce an additional gap at the Dirac point, which is a signature of broken time-reversal symmetry on the surface. These observations establish the Floquet-Bloch bands in solids and pave the way for optical manipulation of topological quantum states of matter.

[Introduction and transformation of the psychiatric term "anancasm". From Gyula (Julius) Donáth via Kurt Schneider to ICD-10]

The conceptual history of "anancasm" in psychiatry remains almost unexplored and this article will help to remove this deficit. It was the Budapest-based neuropsychiatrist Gyula Donáth (1849-1944) who first proposed this Greek-rooted term in 1897 as an international term for compulsive symptoms and as an independent mental illness similar to present-day obsessive compulsive disorders (ICD-10). By suggesting this term Donáth wanted to extend the concept of compulsion as proposed by his teacher Carl Westphal to other compulsive phenomena, psychomotor impulses and restrictions including echolalia, coprolalia, echokinesis, echopraxia, contemporary maladie des tics (present day Tourette's syndrome) and even intermittent dipsomania (craving for alcohol), paraphilias, sexual fetishes and homosexuality. In 1923 Kurt Schneider used this term for a subgroup of psychopathic personalities, the so-called insecure anancastic psychopaths. His concept was much different to that suggested by Donáth, with the only thing in common being the compulsory component. Schneider's anancasts suffered from feelings of insecurity and insufficiency and were forced to try to overcompensate by being excessively careful, meticulous and hyper-correct. Based on Schneider's concept anancasm has survived as a name for a subdivision of compulsive personality disorders in ICD-10; however, these rather complex personality defects were not what Donáth had in mind when he first suggested the term anancasm. The paper discusses further discrepancies between Donáth, Schneider and ICD-10.

[50 years Rodewisch theses--for the beginnings of social-psychiatric reforms in East Germany (GDR)]

The so-called Rodewisch Theses of 1963 demonstrate East German psychiatry's attempts to implement social-psychiatric reforms. To mark their 50th anniversary, this article analyses their emergence, drafting and implementation. It has been known that key requirements could only be fulfilled on a regional basis, the Leipzig University Department of Psychiatry being an outstanding example, although its staff worked rather autonomously of the Rodewisch Theses. The reasons for the different degree of success of these developments in individual areas are manifold, key reasons being the lack of stark political support and of opportunity to discuss shortcomings in mental health care, as in Western Germany, due to political circumstances in particular. There was no strong social basis and support as in Western democracies.

Efficacy and safety over 26 weeks of an oral treatment strategy including sitagliptin compared with an injectable treatment strategy with liraglutide in patients with type 2 diabetes mellitus inadequately controlled on metformin: a randomised clinical trial

AIMS/HYPOTHESIS

The aim of this work was to compare treatment intensification strategies based on orally administered vs injectable incretin-based antihyperglycaemic agents in patients with type 2 diabetes mellitus on metformin monotherapy.

METHODS

In a 26 week, open-label study, 653 patients (baseline HbA1c = 8.2% [66 mmol/mol]) were randomised at 111 sites in 21 countries in a 1:1 ratio to a strategy using oral agents (starting with sitagliptin 100 mg/day) or a strategy using the injectable drug liraglutide starting at a dose of 0.6 mg/day, up-titrated to 1.2 mg/day after 1 week. The following patients with type 2 diabetes mellitus were recruited for the study: those aged 18-79 years, on a stable dose of metformin monotherapy ≥1,500 mg/day for ≥12 weeks, with an HbA1c ≥7.0% (53 mmol/mol) and ≤11.0% (97 mmol/mol) and a fasting fingerstick glucose (FFG) <15 mmol/l (<270 mg/dl) at the randomisation visit, deemed capable by the investigator of using a Victoza pen injection device (containing 6 mg/ml liraglutide; Novo Nordisk, Bagsværd, Denmark). Women taking part in the study agreed to remain abstinent or use an acceptable method of birth control during the study. Randomisation was performed via a computer-generated allocation schedule using an interactive voice response system. After 12 weeks, patients on sitagliptin with HbA1c  ≥ 7.0% (53 mmol/mol) and fasting glucose >6.1 mmol/l had their treatment intensified with glimepiride; patients on liraglutide with HbA1c  ≥ 7.0% (53 mmol/mol) had the dose up-titrated to 1.8 mg/day. The primary analysis assessed whether the strategy using oral drugs was non-inferior to that using an injectable drug regarding HbA1c change from baseline at week 26 using a per-protocol (PP) population and a non-inferiority margin of 0.4%.

RESULTS

In the PP population (522 patients included: oral strategy, n = 269; injectable strategy, n = 253) antihyperglycaemic therapy was intensified at week 12 in 50.2% and 28.5%, respectively. HbA1c decreased over 26 weeks in both treatment strategy groups, with a larger initial reduction at week 12 in the injectable strategy group. The LS mean change in HbA1c at week 26 was -1.3% (95% CI -1.4, -1.2) in the oral strategy group and -1.4% (95% CI -1.5, -1.3) in the injectable strategy group; the study met the non-inferiority criterion. Both treatment regimens were generally well tolerated; hypoglycaemia was reported more often with the oral strategy, while nausea, vomiting, diarrhoea and abdominal pain were reported more often with the injectable strategy.

CONCLUSIONS/INTERPRETATION

An oral, incretin-based treatment strategy with sitagliptin and, if needed, glimepiride may be a good approach in many patients with type 2 diabetes mellitus for managing inadequate glycaemic control on metformin monotherapy, as compared with an injectable treatment strategy with liraglutide. The oral and injectable strategies had similar effects on HbA1c and had good overall tolerability. Trial registration ClinicalTrials.gov NCT01296412 Funding The study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck and Co., Inc., Whitehouse Station, NJ, USA.

[The discussion about the application and impact of music on depressive diseases throughout history and at present]

Music therapy is the customised application of music for therapeutic use. For the treatment of depression it is mostly applied within a multimodal therapeutic approach. Since music was already used in prehistoric societies to cure diseases, it can be considered as a traditional therapy. As early as the antiquity physicians discussed the kind of music, the duration and frequency of its application. In the 19th century the pioneers of modern scientific psychiatry began to follow these questions with empirical experimental research. Since the 20th century, research has been investigating the influence of music on biological and psychological parameters. Current studies show that music therapy appears to improve symptoms of depression, especially in combination with antidepressants. Due to the limited number of randomised studies, the validity of its efficiency is limited. Further research is necessary to provide evidence-based recommendations regarding music therapy for the treatment of depression.

Visceral smooth muscle α-actin deficiency associated with chronic intestinal pseudo-obstruction in a Bengal cat (Felis catus x Prionailurus bengalensis)

An adult Bengal cat (Felis catus × Prionailurus bengalensis) with a prolonged history of partial anorexia, regurgitation, and weight loss and a clinical, radiographic, and ultrasonographic diagnosis of persistent megaesophagus and gastrointestinal ileus was submitted for necropsy. The intestinal tract was diffusely distended by gas and fluid with appreciable loss of muscle tone and an absence of luminal obstruction, consistent with the clinical history of chronic intestinal pseudo-obstruction. Histologically, the autonomic nervous system was intact, but the smooth muscle within the gastrointestinal wall exhibited a marked basophilia that was most pronounced in the jejunum. Immunohistochemistry for neurofilament, synaptophysin, CD117, and desmin demonstrated that the number of myenteric ganglia, number of interstitial cells, and leiomyocyte desmin content were similar when compared with the unaffected age- and species-matched control. Immunohistochemistry for smooth muscle α-actin demonstrated a striking loss of immunoreactivity, predominantly in the circular layer of the jejunum, that corresponded with the tinctorial change in leiomyocytes. Transmission electron microscopy revealed loss of myofibrils, loss of organelle polarity, and significantly larger central mitochondria (megamitochondria) in affected leiomyocytes, as well as nonspecific degenerative changes. Although the presence of a primary leiomyopathy and a causal relationship could not be confirmed in this case, leiomyopathies are considered a cause of chronic intestinal pseudo-obstruction in human medicine, and loss of smooth muscle α-actin immunoreactivity is one recognized marker for intestinal dysmotility.

Emil Kraepelin's habilitation and his thesis: a pioneer work for modern systematic reviews, psychoimmunological research and categories of psychiatric diseases

OBJECTIVES

Although Kraepelin and his oeuvre have been in scientific focus over the past decades, main aspects have still been neglected. Thus the exact circumstances under which and on what topic Kraepelin wrote his habilitation thesis and qualified as university lecturer (in Germany the prerequisite to be appointed as professor) are still widely unknown.

METHODS

This study reconstructs his habilitation at the Medical Faculty of Leipzig University in 1882.

RESULTS

The study reveals the difficulties he had to habilitate on a topic from Wilhelm Wundt's experimental psychology and the opposition he faced from Paul Flechsig. Yet Kraepelin succeeded, mainly due to a positive review by neurologist Wilhelm Erb on his study "On the Influence of Acute Diseases on the Development of Mental Illnesses" (1881/82).

CONCLUSIONS

This work must be regarded as his actual habilitation thesis. It provides an update of organic psychiatric disorders following acute inflammatory diseases and a meta-analysis on the basis of raw data. In addition it discusses possibilities to categorize and understand the pathophysiological mechanism of these disorders and to classify them into those appearing when the fever rises and those occurring when it falls, which has a high impact from a very modern psychoimmunological viewpoint.

Johann Christian August Heinroth: psychosomatic medicine eighty years before Freud

Most often it is assumed that the 'psychosomatic' concept originated from psychoanalysis. However, this term had already been introduced into medical literature about 80 years before Sigmund Freud - namely by Johann Christian August Heinroth, the first professor of psychiatry and psychotherapy in the western world. Widely through quotations from his works, the authors analyze Heinroth's understanding of the interrelations between the body and the soul. For Heinroth both formed a unified, indivisable whole, which interacted in many ways, including pathologically. According to him, a mental illness had its cause in the patient's leading a 'wrong life'. This 'wrong life' deranged the soul from its normal functioning. In a second step, this derangement can have an impact on the body and produce the somatic symptoms that accompany a mental illness. Since both 'components' of the 'indivisible whole' were affected, it was clear for Heinroth that doctors needed to view their patients holistically and treat the whole person. Since in the end the somatic symptoms were caused by an underlying mental derangement, this needed to be treated in the first place - and the psyche could only be reached by direct psychological intervention. Hence what he called his 'direct-psychische Methode' ought to be the remedy of choice for mental illnesses. Through his clear understanding of the interactions of body and soul and by integrating somatic and psychological therapies into a holistic, unified treatment programm, Heinroth is of major importance for the history of psychosomatic medicine.

[An Early Social-Psychiatric Work in the GDR]

OBJECTIVE

In 1966 the Leipzig neuropsychiatrist and psychotherapist Christa Kohler qualified as a university lecturer on social-psychiatric problems in patients aged 40 + suffering from psychoses and neuroses. This paper acknowledges this habilitation thesis in its historical context as an early contribution to East German social psychiatry.

METHODS

First the thesis itself is searched for points characteristic of Kohler's approach to social psychiatry. Parallel to that, her views are contextualised with other primary sources from or secondary sources about GDR psychiatry at that time. Finally archival sources and oral testimonies of eye witnesses have been considered to substantialise the study.

RESULTS

The habilitation thesis is based on data from several hundreds of patients with regard to their demographic, medical and sociological features. Her approach to how older patients suffering from mental illnesses should be treated and rehabilitated is still highly relevant. Yet one must critically assess that many of Kohler's results as well as her psychotherapeutic treatment were ideology-based or oriented on the GDR system.

CONCLUSIONS

Kohler's approach shows a clear, yet improper amalgamation of medical science and political ideology. Future research must show in how far this is typical for her concept only or for the whole of GDR social psychiatry.

A pioneer work on electric brain stimulation in psychotic patients. Rudolph Gottfried Arndt and his 1870s studies

BACKGROUND

Today's brain stimulation methods are commonly traced back historically to surgical brain operations. With this one-sided historical approach it is easy to overlook the fact that non-surgical electrical brain-stimulating applications preceded present-day therapies.

OBJECTIVE/HYPOTHESIS

The first study on transcranial electrical brain stimulation for the treatment of severe mental diseases in a larger group of patients was carried out in the 1870s.

METHODS

Between 1870 and 1878 German psychiatrist Rudolph Gottfried Arndt published the results of his studies in three reports. These are contextualized with contemporary developments of the time, focusing in particular on the (neuro-) sciences. As was common practice at the time, Arndt basically reported individual cases in which electricity was applied to treat severe psychoses with depressive symptoms or even catatonia, hypochondriac delusion and melancholia. Despite their lengthiness, there is frequently a lack of precise physical data on the application of psychological-psychopathological details. Only his 1878 report includes general rules for electrical brain stimulation.

RESULTS

Despite their methodological shortcomings and lack of precise treatment data impeding exact understanding, Arndt's studies are pioneering works in the field of electric brain stimulation with psychoses and its positive impacts. Today's transcranial direct current stimulation, and partly vagus nerve stimulation, can be compared with Arndt's methods. Although Arndt's only tangible results were indications for the application of faradic electricity (for inactivity, stupor, weakness and manic depressions) and galvanic current (for affective disorders and psychoses), a historiography of present-day brain stimulation therapies should no longer neglect studies on electrotherapy published in German and international psychiatric and neurological journals and monographs in the 1870s and 1880s.

Measurement of intrinsic dirac fermion cooling on the surface of the topological insulator Bi2Se3 using time-resolved and angle-resolved photoemission spectroscopy

We perform time- and angle-resolved photoemission spectroscopy of a prototypical topological insulator (TI) Bi(2)Se(3) to study the ultrafast dynamics of surface and bulk electrons after photoexcitation. By analyzing the evolution of surface states and bulk band spectra, we obtain their electronic temperature and chemical potential relaxation dynamics separately. These dynamics reveal strong phonon-assisted surface-bulk coupling at high lattice temperature and total suppression of inelastic scattering between the surface and the bulk at low lattice temperature. In this low temperature regime, the unique cooling of Dirac fermions in TI by acoustic phonons is manifested through a power law dependence of the surface temperature decay rate on carrier density.

Efficacy and safety of initial combination therapy with sitagliptin and pioglitazone in patients with type 2 diabetes: a 54-week study

AIM

To assess the 54-week efficacy of initial combination therapy with sitagliptin and pioglitazone, compared with pioglitazone monotherapy, and to assess safety in these groups during the 30 weeks after the dosage of pioglitazone was increased from 30 to 45 mg/day, in drug-naÏve patients with type 2 diabetes mellitus and inadequate glycaemic control [haemoglobin A1c (HbA1c) 8-12%].

METHODS

Following a 24-week, randomized, double-blind, parallel-group study (Sitagliptin Protocol 064, Clinicaltrials.gov: NCT00397631; Yoon KH, Shockey GR, Teng R et al. Effect of initial combination therapy with sitagliptin, a dipeptidyl peptidase-4 inhibitor, and pioglitazone on glycaemic control and measures of beta-cell function in patients with type 2 diabetes. Int J Clin Pract 2011; 65: 154-164) in which patients were treated with the combination of sitagliptin 100 mg/day and pioglitazone 30 mg/day or monotherapy with pioglitazone 30 mg/day, patients entered a 30-week extension study. In the extension study, the pioglitazone dose was increased from 30 to 45 mg/day in both groups. Depending upon treatment allocation, patients took one tablet of sitagliptin 100 mg or matching placebo daily. Pioglitazone was administered in an open-label fashion as a single 45-mg tablet taken once daily. Patients not meeting specific glycaemic goals in the extension study were rescued with metformin therapy. Efficacy and safety results for the extension study excluded data after initiation of rescue therapy.

RESULTS

Of the 520 patients initially randomized, 446 completed the base study and, of these, 317 entered the extension. In this extension study cohort, the mean reductions from baseline in HbA1c and fasting plasma glucose (FPG) at the end of the base study (week 24) were -2.5% and -62.1 mg/dl with the combination of sitagliptin 100 mg and pioglitazone 30 mg versus -1.9% and -48.7 mg/dl with pioglitazone monotherapy. At the end of the extension study (week 54), the mean reduction in haemoglobin A1c (HbA1c) was -2.4% with the combination of sitagliptin 100 mg and pioglitazone 45 mg versus -1.9% with pioglitazone monotherapy [between-group difference (95% CI) = -0.5% (-0.8, -0.3)] and the mean reduction in FPG was -61.3 mg/dl versus -52.8 mg/dl, respectively [between-group difference (95% CI) = -8.5 mg/dl (-16.3, -0.7)]. Safety and tolerability of initial treatment with the combination of sitagliptin and pioglitazone and pioglitazone monotherapy were similar. As expected, increases in body weight from baseline were observed in both treatment groups at week 54: 4.8 and 4.1 kg in the combination and monotherapy groups, respectively [between-group difference (95% CI) = 0.7 kg (-0.7, 2.1)].

CONCLUSION

In this study, initial combination therapy with sitagliptin 100 mg and pioglitazone 30 mg increased to 45 mg after 24 weeks led to a substantial and durable incremental improvement in glycaemic control compared with initial treatment with pioglitazone monotherapy during a 54-week treatment period. Both initial combination therapy with sitagliptin and pioglitazone and pioglitazone monotherapy were generally well tolerated (Clinicaltrials.gov: NCT01028391).

Johann Christian August Heinroth (1773–1843): the first professor of psychiatry as a psychotherapist

Heinroth is known as the first professor of psychiatry. His chair was established 200 years ago on the 21st of October 1811. His major importance for the history of psychotherapy has not yet been acknowledged. Heinroth regarded restriction as well as activation as fundamental remedies for mental illnesses. Restriction meant making a voluntary decision to live a life based on religious faith and to abstain from earthly satisfaction. Within his specific psychotherapeutical module—the ‘‘direct-psychic’’method—he utilized the patient’s mental powers—mood, mind and will, but also his spirituality. His therapeutic approach additionally contained elements of cognitive,behavioral and conversational therapy.

[Schizophrenic disorders. The development of immunological concepts and therapy in psychiatry]

Immunological changes reported in patients with schizophrenia may play an aetiological role in these disorders. Further, immunomodulatory medications can influence the symptoms of psychiatric disorders. Antipsychotic agents such as clozapine may act therapeutically through the modulation of the immune system and also lead to side effects in that domain.Both the understanding and factual foundations of immunological concepts and immunological therapies of schizophrenic disorders have changed throughout the history of medicine. These are important considerations in psychiatry where diagnostic, nosological and therapeutic complexity is the norm. The article exemplarily presents publications of the psychiatrists such as Julius Wagner von Jauregg, Lewis Campbell Bruce and Friedrich Ostmann as well as neuropathologist Hermann Lehmann-Facius and haematologist William Dameshek.

[Christa Kohler's "communicative psychotherapy" as an integrated psychotherapeutic concept and its biographical, scientific and historical context]

"Communicative psychotherapy" was developed in the 1960s by the East German psychotherapist and psychiatrist Christa Kohler (1928-2004) for the treatment of "neuroses". Similar to established present-day psychotherapeutic methods, such as cognitive behaviour therapy, it combined diverse therapeutic approaches into an integrated treatment programme. This included individual and group therapy, exercise, work and occupational therapy. In contrast to modern psychotherapeutic practice, communicative psychotherapy was based on a firm system of values, namely socialist ideals. According to this system, psychological breakdown was viewed and treated ideologically. In addition, any lack of conformity with the East German system was likewise regarded as a psychopathological deviation, which should be subjected to psychological treatment. The latter concept requires a critical analysis from a current-day perspective. For the first time, this paper concentrates on Kohler's work on neuroses and the theory and practice of her communicative psychotherapy, albeit without neglecting Kohler's other scientific works, her biographical information and her Stasi documents.

Roland Kuhn-100th Birthday of an Innovator of Clinical Psychopharmacology

On the occasion of his 100th birthday this letter is to pay tribute to Swiss psychiatrist and psychopharmacologist Roland Kuhn (1912-2005), who established the antidepressant effects of imipramine starting in 1956. Since until now only monoaminergic-based antidepressants such as this substance found their way into psychopharmacological therapy, one can say that Kuhn established the lead antidepressant substance and has hence fundamentally changed clinical psychiatry and care for the mentally ill.

Else Steinert née Loewenheim (1879-1948): one of Germany's first female specialist ophthalmologists

This study of Else Steinert presents one of the first women in Germany to specialize as an ophthalmologist. Merely tolerated as a guest listener, she conducted most of her studies in Leipzig (1900-1905) and acquired her doctor's licence there. During World War I she worked as assistant at the Ophthalmology Clinic at Leipzig University under Hubert Sattler (1844-1928), but soon thereafter was displaced by her male colleagues returning from the War. Between 1920 and 1937 the young widow and mother of three had a private practice, first in Leipzig and then in Idar-Oberstein, which was one of the first ophthalmology practices to be opened by a female doctor on a national scale. After the Nazis had seized power and she had thus been declared a Jew, her doctor's licence was withdrawn and in this manner she was deprived of her livelihood. To escape being deported to a concentration camp she fled and survived World War II in the countryside of Bavaria. Her MD thesis of 1920, of which only an eight-page abridged version has survived, is a contribution to the debate on the indication and prognosis of Elliot's trepanation for the treatment of glaucoma. Based on her investigations she strongly recommended this operation for all patients with severe glaucoma.

[Erwin Gustav Niessl von Mayendorf and his impact on the conceptional history of aphasia]

Throughout his life Erwin Gustav Niessl von Mayendorf (1873 - 1943) dealt with aphasia, yet so far his studies have been neglected in the historiography of the illness. Niessl followed a unique approach which stood in contrast to both theories that dominated discussion in the first half of the 20th century - locationalism and antilocationalism. This may help explain why he fell prey to oblivion. Yet in fact it is worthwhile remembering his studies, in particular since they might enrich present-day discussions. Although supporting the notion that centres where signals and stimuli are perceived could be located in the brain, he strongly rejected the localisation of cognitive processes. For him these were the result of association. Furthermore Niessl stressed the role of the non-dominant and hence untrained right hemisphere for aphasic symptoms standing in to replace the injured or destroyed left one - a fact that now may be found from recently published fMRI trials.

Control over topological insulator photocurrents with light polarization

Three-dimensional topological insulators represent a new quantum phase of matter with spin-polarized surface states that are protected from backscattering. The static electronic properties of these surface states have been comprehensively imaged by both photoemission and tunnelling spectroscopies. Theorists have proposed that topological surface states can also exhibit novel electronic responses to light, such as topological quantum phase transitions and spin-polarized electrical currents. However, the effects of optically driving a topological insulator out of equilibrium have remained largely unexplored experimentally, and no photocurrents have been measured. Here, we show that illuminating the topological insulator Bi(2)Se(3) with circularly polarized light generates a photocurrent that originates from topological helical Dirac fermions, and that reversing the helicity of the light reverses the direction of the photocurrent. We also observe a photocurrent that is controlled by the linear polarization of light and argue that it may also have a topological surface state origin. This approach may allow the probing of dynamic properties of topological insulators and lead to novel opto-spintronic devices.

[On the history of one form of social psychiatric care: family care exemplified on the Leipzig-Dösen asylum]

On the basis of archival sources and primary literature the study exemplifies the history of one form of extramural social psychiatric care on the example of one particular institution, the town asylum of Leipzig-Dösen. Family care was introduced in Leipzig in 1904 by Georg Lehmann, primarily as an alternative treatment option. After initial opposition among the local population had been defeated, this form of treatment was soon quite accepted. Due to the socioeconomic changes as a result of World War I, the extent of family care was downsized. From 1940 family care in Dösen was abolished, due to a change in ideology. Part of the patients previously in family care fell victim to the National socialist T-4 programme to murder chronically mental ill. However, this study could also prove that at least one third of these patients survived. It can only be presumed to which extent this was due to their physical work being needed as a result of war shortages.

[Forensic-psychiatric opinion at the beginning of the 19th century. Theory and practice in Johann Christian August Heinroth (1773-1843)]

OBJECTIVE

In recent years, Leipzig psychiatrist Johann Christian August Heinroth has attracted more and more attention, yet his forensic-psychiatric works have largely been neglected.

METHODS

Therefore this study takes a close look at his System der Psychisch-Gerichtlichen Medizin (1825) and his Gerichtsärztliche- und Privatgutachten (1847) to examine his theoretical and practical approach to examining offenders.

RESULTS AND CONCLUSIONS

Heinroth wanted to give forensic-psychiatric opinion on the responsibility of specialist physicians and to implement training for them. He also set up firm criteria for reports, both as regarded content and form. In such reports, he made a full review of the culprit's medical history, present physical and mental state and capabilities, as well as of any influences that might have had an impact on the deed. He also ruled that a specialist's report was to help the judge, but not to replace the judge's work. Heinroth's own works reveal his ideas, as well as his rejection of the exploitation of (assumed) mental disorders to gain exculpation for offenders.

Electrotherapeutic disputes: the 'Frankfurt Council' of 1891

Since the 1980s and 1990s, vagus nerve and deep brain stimulation, transcranial magnetic stimulation and cranial electrotherapy stimulation have found their way into neurology as therapeutic approaches to epilepsy, Morbus Parkinson and other central nervous symptoms. Moreover, these methods have proven useful and provided hope in the therapy of other diseases, most of all in psychiatry. From a historic perspective, this new emphasis on somatic therapies in the case of transcranial magnetic stimulation and cranial electrotherapy stimulation represents the return of therapeutic methods widely used in the 19th century and based on very similar techniques. Against the background of a general rise in the importance of neurobiological concepts in the neurosciences, we are now in a new situation of change. Yet, as in the 1880s and 1990s, many epistemic questions remain unresolved, the methods not yet having been standardized. In particular, the inability to explain which way and precisely how electricity induces healing processes in the body continues to put the neurosciences, which have always regarded themselves as exact and scientific in nature, in a rather uncomfortable position. There was a similar situation in the 1880s and 1990s, when positivist scientific dogmas prevailed. For ideological and professional reasons, neurologists strongly rejected the notion pioneered by Leipzig neuropsychiatrist Paul Julius Möbius that curative effects of electrotherapy were based on suggestion. One should see, however, that Möbius's actual concern was not to raise opposition towards or question electrotherapy as such, but rather to sensitize his colleagues in view of the prevailing solely materialistic-somatic approach in order that they should not neglect the psychological component of all illness, both in clinical practice and in research. A singular and very special event illustrates the heated debate among German-speaking neurologists on the psychological/suggestive effects of electrotherapy in the last decade of the 19th century-namely the 'Frankfurt Council' of 1891. The statements made at the Frankfurt convention of 35 leading electrotherapists in opposition to Möbius's criticism very much resemble present-day arguments and attitudes. Yet neuroscientists of earlier generations also found very individual answers to fundamental questions in their field that might help both to understand problems from a long-term perspective and enrich present-day discussion as a beneficial corrective.