A typical problem concerning in-patient detoxification is the high drop-out rate. This phenomenon represents a significant problem for both the patient and the therapeutic team, as it is a factor which reduces motivation. While several studies confirm a positive shift of early drop-out behavior with the aid of methadone-supported detoxification, the overall drop-out rate still saw no improvement. Unexpectedly the latter rate was found to be around 50 %. The aim of the present study was to determine the sociodemographic, dispositional and addiction-related factors, as well as subjective ratings of the present state, which have predictive value, i. e. which could discriminate drop-outs from those patients who bring their detoxification to a regular end. 176 patients from two different clinical detoxification wards of the Hannover Clinic of Psychiatry and Psychotherapy participated in the study. The overall drop-out rate was 49.4 %, the rate of female patients failing to conclude detoxification was significantly higher than that of males (68.4 % vs. 44.2 %). On average drop-out patients were 2.2 years younger and their former (i. e. uninterrupted) periods without drug consumption were shorter, while criminal circumstances (e. g. therapy as probation vs. voluntary participation) did not play a major role in influencing staying power. As expected, patients terminating their treatment against medical advice evaluated the therapeutic program more critically than the others. Interestingly drop outs rated their own mental and somatic condition very pessimistic. We concluded from these results two essentials being necessary to improve staying power of drug patients during clinical detoxification: systematic induction of (1) a positive self concept and (2) an optimistic view of chances to reach social adjustment and health.

Kleptomania is not supposed to be a nosologic entity, but represents a psychopathological symptom of variant neurological and psychiatric diseases. A 47-year-old woman had shown a kleptomanic impulse disorder on the basis of a phobic personality organisation, until she suffered a spontaneous subarachnoidal haemorrhage with a consecutive basal forebrain lesion five years ago. After this event the kleptomanic symptom worsened dramatically. This case suggests an integrated "neuropsychodynamic" approach to clinical findings, which are commonly to be interpreted neuropsychologically and psychodynamically. We discuss the many mutual overlappings of neurobiologically determined and biographically understandable psychic phenomena.