Every physician knows that alcohol dependence, alcohol withdrawal and Wernicke-Korsakow-syndrome require substitution with thiamine, in acute stages even parenterally. This would be trivial if there was not the widespread fear of anaphylactic, even lethal reactions to parenteral thiamine application. The present article reviews the literature published on thiamine since 1936, when the first synthetic, parenteral thiamine preparation became available, and, on this basis, tries to give practical advice and therapeutic regimens for the treatment of thiamine deficiency states. Controlled clinical studies on indications and differential thiamine therapy have not been published. From the data that are available, the following conclusions can be drawn: 1) Acute mortality of Wernicke-Korsakow-syndrome is about 20%. 2) Oral thiamine is safe. 3) The risk for an anaphylactic shock due to parenteral thiamine administration is below 1 to 100,000. 4) Not only alcohol but any condition with either increased metabolic need (pregnancy, consuming diseases) or deficient nutrition (including eating disorders) can lead to thiamine deficiency. Therefore, we suggest: 1) Oral thiamine substitution with at least 50 mg per day and supply of a sufficient and complete diet should be given to any person that might be at risk for thiamine deficiency. 2) Any patient suspicious for acute thiamine deficiency needs to be treated under inpatient conditions and there needs to receive 50 to 100 mg thiamine intravenously 3 to 4 times a day. 3) General practitioners, psychiatrists and neurologists should take care of the oral supplementation of thiamine, sufficient nutrition, and they are the physicians to diagnose early stages of thiamine deficiency.

105 of the the German Jugendgerichtsgesetz (JGG, law on criminal cases involving offenders between 14 and 17 years of age) allows the use of this special law also for offenders between 18 and 21 years of age if they can be considered juveniles with regard to their personal development or the type of crime they have committed. Assessment of the "maturity" of young people in this age group has been the subject of great controversy in forensic psychiatry since the first JGG went into effect in 1953. In spite of numerous attempts to operationalize the term "Jugendlicher", for example in the Marburg guidelines, it has not yet been possible to establish clear-cut criteria defining the characteristics of those who are juveniles in the sense of the JGG. Neither child and adolescent psychiatry nor criminal law nor criminology has provided an adequate basis for such a definition. The wide range of discretionary decisions in forensic psychiatry and the associated lack of legal uniformity may, however, be a necessary prerequisite for an adequate assessment of an individual case. Although the chances of a change in criminal law governing those between 18 and 21 are small, creation of a law specifically for this age group, with a separation of the educational-therapeutic aspects from the punishment aspects, could be a great help to those preparing expert opinions in forensic psychiatry and to the juvenile courts because it would necessitate greater clarity in decisions relating to this group of offenders. Elimination of Section 105 JGG and the subsequent use of either general criminal law or that governing those under age 18 only, which has been proposed repeatedly, is not recommended.

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