Duties of a psychiatric-neurological consultation/liaison service in a prison setting.

Demonstrated are standards for diagnostic and therapeutic competence deriving from the duties of a psychiatric-neurological consultation/liaison service maintained in a German prison over a 4-year period. Homogeneous age distribution (32.5 +/- 4.4 years) and the lower social status of the patients characterized the mental disorders observed in the male multinational group of patients investigated (n = 170). These included schizophrenic, affective, neurotic and psychosocial stress disorders, alcohol and drug dependence and specific personality disorders. Besides tendencies towards dissimulation, culture-bound differences in symptomatology, the phenomenon of malingering and the reluctance of prisoners, by reason of their status as such, to divulge personal information on relevant aspects of personal identity were factors complicating the diagnostic process. Epileptic syndromes and lesions of the peripheral nervous system dominated the profile of neurological diseases, mandating experience in all established technical examination procedures of neurology. Therapeutic competence in psychiatry and neurology has to satisfy not only the diversity of the manifest diseases and disorders, calling for cooperation with various medical specialists and hospitals, it must also recognize particularly the limitations of therapy in a prison setting (e.g. observation of suicidal patients). Confidentiality and transparency of medical behavior are absolute variables in the treatment of prisoners that can be rather easily realized in a consultation/liaison service.