The objective of our psychopathological analyses is to shed light on the position of irritable mood (dysphoria) in psychiatric diagnostics and nosology. In today’s most commonly applied classification systems, the ICD-10 and the DSM-IV, dysphoria is mentioned mostly in the context of diagnostic criteria of personality and affective disorders. Other authors have emphasized the importance of dysphoric states in organic psychoses and delusional disorders. Summarizing the various publications on the nosological position, dysphoria is a nosological nonspecific syndrome which may occur in the course of all psychiatric disorders and illnesses. According to the results of our psychopathological analyses, the pathogenesis of dysphoria has to be considered as a multidimensional circular process in which various mental, physical and social factors act as predisposing, triggering and disorder-maintaining factors. Stressors induced by particular experiences and perceptions and by impaired health may lead to a dysphoric state if adequate coping mechanisms are missing. Dysphoria itself usually leads to a deterioration in the mental and physical state of the patient, and shows a clear impact on the patient’s social network. The reactions of people close to the patient combined with the impaired mental and physical conditions of the patient cause the circle to restart. As contemporary diagnostic entities do not refer to pathogenesis, classical categorical diagnostics cannot provide the basis for effective pathogenesis-oriented therapy. A change of paradigm in diagnostics from a categorical to a dimensional approach thus becomes necessary. Following a dimensional diagnostic approach based on a dynamic model of vulnerability, a precise differential diagnosis of the complex constellation of conditions and their interactions becomes necessary in order to develop effective treatment strategies. Disorder-maintaining factors determine the treatment of the acute symptomatology, whereas predisposing and triggering factors serve as the basis for the prophylactic treatment.

A main problem of the psychodermatological classifications available today is that the assignment to classes is based on more or less unproven assumptions and postulations concerning pathogenesis and nosology. Another problem we are confronted with in psychodermatological classifications is the inconsistency with respect to selection criteria and definition of diagnostic classes. This unsatisfactory diagnostic situation was the incentive to develop the Vienna Diagnoses Schedule for Psychodermatological Disorders (VDS). In this classification, the disorders or problems we are confronted with in general psychodermatology wards are attributed to four main diagnostic categories: The first category includes mental disorders without dermatological symptoms, the second mental disorders and dermatological disorders combined, the third dermatological disorders without any mental disorder, and the fourth dermatological and/or psychological problems not reaching the level of a disorder. The main requirement for diagnostics is the improvement of communication in daily practice on the one hand and the clinical relevance of diagnoses with respect to treatment and prognosis on the other hand. The VDS may help to achieve the first objective. As no categorical classification of mental disorders may fulfill the second requirement, it is necessary to change the paradigm in diagnostics in order to develop more effective pathogenesis-oriented treatment strategies. A possible alternative to the classical categorical approach may be a pathogenesis- oriented, dimensional approach. According to the results of empirical studies carried out in the past decades, the pathogenesis of a psychodermatological disorder has to be considered a multidimensional process in which various mental, physical, and social factors act as predisposing, triggering, and disorder-maintaining factors. Therefore effective treatment strategies have to be based on an accurate differential-diagnosis including all these factors.

Forty-eight men incarcerated for child molestation were divided into two groups on the basis of the gender of their victims: (1) exclusively male target and (2) female or both sexes target child molesters.Reinhard Eher is affiliated with the Federal Assessment and Documentation

Evidence consistently demonstrates that people with long-term mental health conditions develop serious physical comorbidities at an earlier age than the average population. These physical comorbidities are often exacerbated because long-term psychiatric conditions reduce the patient's ability to manage somatic symptoms effectively, thus hindering treatment. This highlights the critical importance of continuous support by primary care physicians and nursing staff. People with persistent mental illnesses typically require long-term care significantly earlier than people without mental illness.As a consequence, elderly patients with chronic mental illnesses who are essentially unable or unprepared to function in the outside world or are in need of constant medical attention are typically placed into long-term care facilities and nursing homes geared to serving physically disabled elderly.These LTC institutions have no capacity to provide specific care for mentally ill patients. Difficulties in treating psychiatric patients in these LTC facilities often result in transfers to and repeated admissions in acute psychiatric hospitals.In an effort to resolve the “revolving-door” situation of these patients and reduce the rates of re-admission to acute psychiatric hospitals, Modell Donaustadt was developed. In the talk, Modell Donaustadt will be presented as a best practice example for the treatment of mental and physical comorbidities in long-term care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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