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Background and objective: After the Federal Constitutional Court overturned the ban on business-like assisted suicide in 2020, politicians, society and the medical profession are discussing legal protective measures to prevent abuse. This survey among members of the DGPPN is the first to record the attitudes and experiences regarding assisted suicide of psychiatrists and other mental health workers in Germany, as suicidality and assisted suicide are highly relevant topics for medicine and especially for psychiatry and psychotherapy.

Material and methods: The survey was conducted as an online survey with a specially created questionnaire and a DSGVO-compliant data protection concept and sent to a total of 9356 members. In addition to the descriptive analysis of the questionnaire, the free-text responses were subjected to an additional qualitative analysis. Finally, correlations between sociodemographic variables and relevant items were examined.

Results: A total of 2048 members participated in the survey (22%). Most participants (88%) considered a (new) legal regulation of assisted suicide to be necessary; the separation of counselling, assessment and execution of assisted suicide was mentioned most frequently (76%). The majority considered assisted suicide to be legitimate under certain circumstances when the suicide wish is freely made (72%), especially in cases of high suffering and near the end of life (67%). Age, gender, and religious beliefs were found to be significant influencing factors in several responses.

Conclusion: A large majority of the DGPPN members consider it necessary to find a legal regulation that prevents abuse of assisted suicide; however, while most participants did not consider assisted suicide to be legitimate or illegitimate in principle, but rather made this dependent on the specific circumstances of the suicide wish, more than half ruled out to assist with suicide. The results represent an important contribution to the political debates about legal protective measures.

The term "complex posttraumatic stress disorder" (cPTSD) appeared in the scientific literature 30 years ago and has now been included in a diagnostic catalogue for the first time, namely in the International Statistical Classification of Diseases and Related Health Problems 11 (ICD-11) which was officially published at the beginning of 2022. This usually severely debilitating disorder often poses great challenges to treating physicians and psychotherapists in everyday clinical practice. Due to the much-debated overlap of cPTSD with borderline personality disorder (BPD), which is very high in cases of comorbidity of BPD and PTSD, cPTSD became embroiled in scientific discussions about the raison d'être of BPD in the new dimensional concept of personality disorders (PD) in the ICD-11. In addition to a detailed explanation of the diagnostic criteria of cPTSD and their differentiation from other mental disorders, particularly from PTSD, BPD and dissociative disorders, this article summarizes the historical development of the concept of cPTSD to date and the currently available treatment options. The same criteria apply to cPTSD in childhood and adolescence as in adulthood, but there are some special features that are not addressed in this article.

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.g. in 1961 he became the founding president of the World Psychiatric Association (WPA). Ten years after his death in 1967, when it became known that one of his research projects was covertly cofinanced by the CIA, he was stylized as the incarnation of brainwashing. The public concern with "brain-washing" and the mind control techniques of the CIA embedded in the societal atmosphere of the "cold war" with its conspiracy conjectures (societal context) changed fundamentally the posthumous image of Cameron. In a critical look back the fact remains that Cameron could have realized his research concepts in a clinical context that tolerated his research against the disease and emphasized this as opposed to the immediate suffering of the individual patient and, at the same time did not completely internalize the clear ethical regulations of the year 1948: the Nuremberg Codex, the World Medical Association's- Declaration of Geneva as well as the UN-Declaration of Human Rights. Furthermore, in his socially technical phantasies Cameron was in danger of leaving the socially oriented psychiatric care of mentally ill patients and of slipping down into a totalitarian ideology.

Epidemiological registers on the burden of disease and adverse events (deaths, serious side effects, etc.) play an important role in the management, evaluation, and improvement of healthcare treatment for the population. This also applies to coercive measures in the psychiatric healthcare system. Such registers only became feasible on a broad basis due to the availability of electronic medical records and steadily increasing computing capacities; however, in most German states, registers have not been implemented. Data protection problems must be taken into account in the collation of person-related data but can be solved by appropriate pseudonymization procedures taking the prerequisites of data parsimony into account. Extensive data are now available from the Baden-Wuerttemberg register for coercive measures, which has been in existence since 2015 and which enabled, for instance, evaluating the consequences of the changes to the law following the 2018 ruling of the Federal Constitutional Court on mechanical restraint and the consequences of the coronavirus pandemic. In the meantime, there are also state-wide data collections in some other German states; however, unlike in Baden-Wuerttemberg, these registers do not include measures under guardianship law. A nationwide register for coercive measures, compulsory treatment and involuntary detention has justifiably repeatedly been demanded for a long time. A major obstacle is the historically developed separation between the responsibility of the German states for the detention regulated by public law and the Federal State for the scope of application of the guardianship law.

The reform of the guardianship law has been decided! The reform will come into force on 1 January 2023. The content of the guardianship law will not be completely restructured. The tense relationship between the protection of the person against decisions not made on his or her own responsibility and the self-determination of the person will be consistently further considered and strengthened in favor of the self-determination of the person concerned. Supportive decision making, the consideration of a person's wishes, the abandonment of the term (and concept of) "well-being" as a measure for guardianship are some examples; however, the new law also sets boundaries in adhering to a person's wishes. Namely, if they are associated with the risk of significant harm to the person or his or her property. The article first presents the main objectives of the reform. Based on this, the focal points are the deletion of the word "well-being", the regulation of the proxy power of attorney and measures for greater consideration and better implementation of the principle of the necessity, which is central to the guardianship law. Critical comments are made on the newly introduced spousal representation law and its significance for the psychiatric practice. As a result, it can be stated that there will be hardly any significant changes in healthcare and even less so in the area of coercive measures. It remains to be seen whether the legislator's welcome concern to avoid guardianship through improved information and counselling on social rights will be achieved in practice. The same certainly applies to the strengthening of supported decision making, the idea of which is also to be welcomed but is still looking for a gold standard for practice.

Background: The interpretation of Article 12 of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) by the UN Committee on the Rights of Persons with Disabilities led to a controversy over the implementation of the article in psychiatry.

Objective: How can Article 12 CRPD be implemented in psychiatry in an ethically justifiable way?

Material and method: An empirically and legally informed conceptual and ethical analysis was carried out.

Results: The suggested combined supported decision making model ensures the recognition of people with mental disorders as persons before the law, their equal treatment in the informed consent process and the provision of supported decision making. According to this model, coercive treatment can only be carried out in accordance with the will and preferences of the person and is subject to further conditions of proportionality and review by an independent body.

Conclusion: The combined supported decision making model makes an ethically justifiable implementation of Article 12 CRPD possible in psychiatry.

The verdict of the German Federal Constitutional Court on assisted suicide has led to lively debates in the medical world, in the German Federal Parliament and the civil society. In the conception of the German Federal Constitutional Court the determination of free responsibility is of central importance for a protection concept that aims to minimize an uncontrolled assistance to suicide; however, the forensic aspects of this task need to be substantiated. This article comments on this from a psychiatric aspect in order to include the perspective of our discipline in the progression of the discussion.

The verdict of the German Federal Constitutional Court from 26 February 2020 made it clear that every person is granted the right to end his or her own life, provided it is the person's own free will. It is also within his or her rights to utilize assistance in doing so, if such assistance is offered. This freedom to end one's life and to utilize assistance is not limited to terminal illnesses or situations of unbearable suffering. However, the High Court has also demanded that lawmakers ensure the safety of vulnerable people by making certain that the decision for suicide is in fact made out of the person's own free will. This free decision-making capability can be substantially impaired by acute psychosocial stressors, by mental illnesses but also by third party influence. Therefore, a liberalization of assisted suicide must unconditionally be accompanied by a massive strengthening of suicide prevention measures, which clearly prioritize the help to live over the help to die. This article reviews the scientifically established methods for suicide prevention and makes demands to lawmakers to comprehensively implement such measures.

Objective: This study investigated how the number of sessions for outpatient psychodynamic psychotherapy among patients with depressive disorders is associated with the severity of the disease.

Methods: From a random sample of 1000 applications for reimbursement of outpatient psychodynamic psychotherapy, we selected those in which a diagnosis of depression with a severity rating (ICD-10 F32 or F33) was coded. The association of levels of depression severity (mild, moderate, and severe) with the number of sessions requested and the number of sessions endorsed by the reviewer was investigated using Spearman's rank correlation. If the application was for a continuation of an ongoing therapy, the previous sessions were taken into account too.

Results: A total of 521 (52%) applications contained a diagnosis of F32 and/or F33. Out of these, 63 (12%) were coded as mild, 349 (67%) as moderate, and 50 (10%) as severe. There were 75 sessions applied for in patients with mild depression (median), 50 in patients with moderate depression, and 50 in patients with severe depression, whereby the range within each severity group was considerable (10 to 327 sessions) and the correlation was low (Rho -0.10). The median number of endorsed sessions was 74 in patients with mild depression, 50 in patients with moderate, and 50 in patients with severe depression. Here, too, the range was high (0 sessions to 327 sessions) and the association weak (Rho -0.11).

Discussion: There is no evidence that psychotherapists determine the necessary number of sessions solely based on the severity of the diagnosis.