Behandlung und Teamprozesse in der stationären Psychotherapie

Ohne Zusammenfassung     

Zur Prävalenz von Depersonalisation und Derealisation in der stationären Psychotherapie

Depersonalization (DP) and derealization (DR) remain poorly recognized in clinical routine. Active exploration through structured interviews is strongly recommended, because patients rarely describe spontaneously their experiences with DP/DR. 143 psychosomatic, first-admission inpatients were interviewed about the 1-month prevalence of DP/DR using the Structured Clinical Interview for DSM-IV dissociative disorders. Additionally, the German questionnaires of the Cambridge Depersonalization Scale, the Dissociative Experiences Scale, the SCL-90-R and the Inventory of Interpersonal Problems were used. In the sample we found a prevalence of 23.1% (N=33) for depersonalization-derealization syndrom (ICD-10 F48.1) and 7% (N=10) for secondary pathological DP/DR. A total percentage of 62.9% reported DP/DR to some degree or other. There was a noticeably high co-occurrence of anxiety disorders in patients with pathological DP/DR. Patients with pathological DP/DR were generally more impaired, suffered many more interpersonal problems and were particularly characterized by introversion. Considering the high prevalence of this phenomenon, more attention should be paid to DP/DR in routine diagnostic procedures, treatment and research.     

Berufsgruppen- und methodenintegrierende Teamarbeit in der stationären psychodynamischen Psychotherapie

Zusammenfassung Die über 50-jährige Entwicklung der stationären psychodynamischen Psychotherapie ist ein Prozess von der Anwendung ambulanter psychoanalytischer Verfahren auf der Station zu einem eigenständigen multiprofessionellen, multimethodalen Therapieverfahren. Die Rahmenbedingungen der Organisation Krankenhaus und das jeweilige psychoanalytische Verständnis des Leiters der Abteilung zur Nutzung des multipersonellen Therapiefelds prägte die psychodynamischen Konzeptionen. Die Entwicklung führte zu einer Formulierung einer Komplexbehandlung für stationäre Psychotherapie im Prozedurenkatalog der DRGs. Ein Herzstück der integrativen stationären psychodynamischen Therapie ist das multiprofessionelle Team. An 2 Beispielen von therapeutischen Funktionen des multiprofessionellen Teams wird die gemeinsame Aufgabenstellung des Teams dargestellt. Darüber hinaus werden Regeln aus gruppenanalytischer Sicht für die Leitung eines solchen multiprofessionellen Teams vorgeschlagen.     

Therapieabbrüche in der stationären Psychotherapie

This article focuses on the patients’ view of the causes and consequences of premature therapy termination in inpatient psychosomatic setting. In this study, drop-out patients and non-drop-out patients were questioned in semi-structured phone interviews (n=62). The causes of early termination are seen in this study to be connected with an internal, somatic concept of disease, discontent with treatment, and social interaction problems in the hospital. In 80% of the examined cases more than two causes were reported. Consequently, early termination of treatment can be considered as an outcome of multifactorial influences. Furthermore, a group of “inner drop-outs” has been identified within the non-drop-out patients. Despite high discontent, these patients remained in treatment because they often feared possible negative consequences of early treatment termination. Both drop-outs and inner drop-outs scored lower in outcome analysis than the remaining patients. This study points to problem areas that can help identify potential drop-out patients.     

Response und Non-Response in der station?ren Psychotherapie depressiver Patienten

Background

Poor outcome of psychotherapeutic treatment has not yet been sufficiently investigated. It is assumed that approximately 25–30% of patients are treatment non-responders and about 5–10% suffer deterioration.

Study design and methods

The therapeutic success of a total of 2,323 consecutively admitted inpatients with a depressive episode (F32.0-2, F33.0-2) was evaluated by using different strategies based on self ratings at admission and at discharge, i.e. the Beck depression inventory II (BDI-II) and the brief symptom inventory (BSI). In intention to treat (ITT) and completer analyses various measures of therapy success were compared (e.g. statistical significance, effect sizes and clinical significance).

Results

Effect sizes were 1.59 (BDI-II) and 0.86 (BSI) for the ITT sample and 1.64 and 0.89 for the completer sample. Analyses using criteria of clinical significance resulted in response rates of 75.5% (BDI-II) and of 68.7% (BSI) for completer analyses and remission rates of 62.2% (BDI-II) and of 40.8% (BSI). Non-Response rates, also including minor responders, varied between 23.4% (BDI-II) and 27.4% (BSI). Deterioration was observed in only 1% (BDI-II) and 3.9% (BSI) of the patients.

Discussion

The results demonstrate that about two thirds of depressive patients show clinically significant improvements within a multimodal, primarily psychotherapeutic inpatient setting, whereas the rates of deterioration are lower than expected. The aim for the future should be to identify poor or minor response as early as possible in order to optimize treatment.     

Bulimiebehandlung im stationären und teilstationären Setting

While treatment guidelines for outpatient psychotherapy for bulimia nervosa are known, it is hard to find published concepts for inpatient or day clinic settings. We will describe a treatment program developed in Freiburg/Germany, which integrates symptomoriented, cognitive-behavioral elements into a psychodynamic concept. The program presented can be seen as an example. For implementation at other clinics, it should be adapted to their special context and structure.     

Religiosität und Spiritualität in der Psychotherapie

For many years religious and spiritual issues have been avoided in psychotherapy. In the face of social changes a more culturally sensitive psychotherapy is needed to professionally deal with religious backgrounds, spiritual needs and spiritual resources. A remarkable spiritual turn has recently been observed particularly in psychoanalysis, which was originally very antireligious. Health research studies are exploring the healing craft of religious virtues and values. It is important to discern between an empirically proven healing method and an ideologically founded promise of salvation. It is the task of the therapist to find out whether the patient's religiosity or spirituality is part of the problem or part of the solution.     

Einsatz von „virtuellen Realitäten“ in der Psychotherapie

The internet, as well as various mobile media (e.g. cellular phones, handhelds, mobile paddles) have proven very useful in supporting psychotherapeutic measures in various projects. Virtual reality technologies (VR) take technical as well as intervention possibilities a step further. They enable the creation of computer-based models of the real world, with which interaction via the human-machine interface is enabled. The three-dimensional and interactively explorable environment is predominately used for exposure treatment in the behavior therapy setting. The features of VR applications are utilized as a medium between imagined and in vivo confrontation. This article illustrates various applications and compiles findings regarding effectiveness. It is concluded that the exposure treatments using this technology for various described phobias have proven effective. The use of VR for treatment of other psychological illnesses, however, for example trauma disorders, as was demonstrated in the study at hand, is viewed very critically. Finally, research necessities are indicated and psychodynamic facets of VR are discussed.     

Psychische Störungen und Psychotherapie in der spätmodernen Gesellschaft

The development into a globalized network capitalism has brought enduring change to everyday experiences of humans and affected their self-images and concepts of normality. The new capitalism offered us a specific disturbance panorama which, however, in the language game of clinical diagnostics cannot be named and classified in its social framework. Here is a gap in professional reflection. Psychotherapy needs social diagnostics and for its part can contribute to it. Moreover, it is necessary for psychotherapy to develop its therapeutic technical operating level by a critical alertness for the structural conditions of human life and human suffering.     

Muster früher Traumatisierung und die Effekte stationärer Psychotherapie

Early traumatic experiences of neglect, physical and sexual abuse in adult patients undergoing inpatient psychotherapeutic treatment were retrospectively assessed. Associations between these three forms of trauma and with patient gender were analyzed. The effects of early traumatization in general, gender and patterns of specific experiences on the symptom level, level of everyday functioning and treatment outcome were also investigated. A total of 191 patients in a psychosomatic psychotherapy ward of a university hospital were assessed using standardized questionnaires on sociodemographic and clinical variables on admission and at discharge. The type and extent of early traumatization before the age of 18 years were estimated after the initial interview from standardized reports of the therapists. The results indicate that the probability of being exposed to one of the traumatic experiences under study are not independent of each other. Furthermore, female patients were victims of sexual abuse and neglect more often than males. Compared to non-traumatized patients, trauma victims exhibited more psychological symptoms in the symptom checklist 90 revised (SCL-90-R) and a lower level of functioning according to the global assessment of functioning (GAF) but achieved a comparable relative benefit from treatment. Sexual abuse (SCL-90-R and GAF) and neglect (SCL-90-R only) affected the levels of impairment on admission and at discharge in a similar way; however, only weak evidence for differential effects of trauma patterns on therapy outcomes was found. Methodological limitations of the present approach and implications for the design of inpatient psychotherapeutic interventions in adult patients with early traumatic experiences are discussed.