Mentalisierungsdefizite bei stationären Patienten

Background

Fonagy (2009) considers the improvement of mentalization, understood as an element of structural change, as a global goal of psychotherapeutic treatment. Yet until now there is little knowledge about the mentalizing skills in clinical populations.

Material and methods

We examined the mentalizing skills in 201 patients on admission for complex psychotherapeutic inpatient treatment with the “Reading the mind in the eyes”-Test (RMET). We explored if there are diagnosis-related differences in the RMET and compared our findings to published data on the RMET in clinical and normal populations.

Results

Compared to normal populations our sample scored significantly lower in the RMET, however, no diagnosis-related differences were found.

Conclusions

Although our data are preliminary, psychotherapeutic inpatient treatment should consider the patients reduced mentalizing skills.     

Therapieresistente Depression bei älteren Patienten

Antidepressive monotherapy using selective serotonin reuptake inhibitors leads to satisfactory remission in the first 4 weeks of therapy in only 40?% of clearly depressive patients. After unsatisfactory therapy with serotonin reuptake inhibitors the change to dual antidepressants is most common. An unsatisfactory response also to this second attempt at therapy is referred to as therapy resistance. Therapy resistant depression can necessitate changing to other antidepressants, such as classical cyclic antidepressants. Therapy attempts with atypical antidepressants, such as buproprion or mirtazapin or monotherapy with a monoamine oxidase inhibitor can be carried out; however, success of therapy in severely depressive patients still remains unsatisfactory in at least 20?% of cases even after several pharmacological approaches and even after psychotherapy or augmentation strategies (e.g. lithium and antipsychotics). It is less probable that bipolar depression will respond to antidepressive therapy than recurrent unipolar depression.     

Psychotherapieplanung bei “schwierigen Patienten”

This article describes a model of comprehensive psychotherapy planning for difficult patients, especially patients with borderline personality disorders and psychotic disorders. Its aim is to develop a psychotherapeutically orientated approach to treatment corresponding to the individual needs of the patient and the people closest to them (e.g. family).Central elements of the planning process are diagnostic/therapeutical family meetings in which psychoanalytic and systemic conceptualisations are applied together. The main features of this context oriented model development are described and illustrated by case studies.The article also presents first results of an analysis of the therapy plannings and discusses the questions arising.     

Einsatz von Bupropion bei älteren Patienten

Die chronische bipolare Depression bei ?lteren Menschen ist eine klinische Herausforderung und erfordert unter Umst?nden, wie der vorliegende Fallbericht zeigt, Behandlungswege, die von Leitlinien nicht unbedingt abgedeckt werden.     

Wie stehen Psychoanalyse und Neurowissenschaften zueinander?

In order to achieve a definition of the subject of both sciences, the author differentiates the practical from the natural side of our existence: our natural, neurophysiological configuration permits our way of life, in which we use those in the form of an instrument, in a similar way to that which a singer would use a voice. The differentiation between conditional and causal relations then leads to a basic criticism of neuroscientific positions. The interest of psychoanalysis in neuroscience is ultimately characterized as a pragmatic interest.     

Somatoforme Störungen bei ambulanten dermatologischen Patienten

Zusammenfassung In der vorliegenden Studie wurde die Häufigkeit somatoformer Symptome in einer dermatologischen Universitätsambulanz untersucht. An der Studie nahmen n=195 Patienten teil, die Screeningfragen zu somatoformen, dermatologischen und depressiven Symptomen ausfüllten. Zusätzlich wurde eine dermatologische Beurteilung der Symptome hinsichtlich der Ätiologie erfasst. Danach wiesen 26,2% der Patienten Hinweise auf eine somatoforme Störung auf; am häufigsten waren somatoforme Schmerzstörung (16,9%) und körperdysmorphe Störung (15,4%). Unter den spezifischen dermatologischen Symptomen wurde Juckreiz besonders häufig (10,3%) als somatoform klassifiziert. Der Anteil von Patienten mit erhöhten depressiven Beschwerden lag bei 17,3%. Die Ergebnisse sprechen für eine erhöhte Prävalenz somatoformer Störungen bei dermatologischen Patienten. Die Identifizierung und psychotherapeutische Versorgung dieser Patientengruppe sollte in der dermatologischen Routineversorgung mehr Beachtung finden.     

Lithiumtherapie bei älteren Patienten mit bipolarer Erkrankung

psychopraxis. neuropraxis - Die Behandlung psychiatrischer Erkrankungen mit Lithium bei älteren Patienten ist phasenprophylaktisch so wirksam wie in der Allgemeinbevölkerung und besitzt...     

Psychoonkologische Therapie und Psychoanalyse: ein Widerspruch?

Psycho-oncological psychotherapy and therapeutic work with severely somatically ill patients seems to be an area of limited interest in psychoanalysis. For example, case reports of psychoanalytic treatment with terminally ill patients are rare. This stands in contradiction to the importance of the fear of dying and death (wish) in psychoanalytic theory construction (e.g. narcissism theory). In addition to the obvious differences between psycho-oncological therapy and psychoanalysis, such as limited time perspective, the need for a flexible setting and dealing with the depth of regression, there are also important similarities and in particular the therapeutic work on early unconscious defence processes and coping with the fear of death. The theoretical and clinical work of the French psychoanalyst Michel de M’Uzan on experiences in psychoanalytic treatment of dying patients are an important example but are not well known in the German psychoanalytic community. The way psychotherapists deal with their own separation anxiety and fear of death is still a major issue and a barely appropriately reflected phenomenon, which possible represents a mutual confrontation (or an impossibility?) of psychotherapeutic work with dying patients.     

Zeitlosigkeit und Verg?nglichkeit (in) der Psychoanalyse

The author shows that the accessible psychoanalytic unconscious is not timeless. Freud??s ??timeless unconscious??, which was ontologized by himself and his successors, proves to be fiction with negative consequences. Assuming ??timeless?? primary processes psychoanalysis as a therapy would bite the hand which feeds it. Instead of contrasting linear time to the cyclic personal experience of time, the author suggests to speak about the ??emergence of lived time?? and the ??new moments?? of encounter in the therapeutic situation, to emphasize the importance of the opportune moment for change in contrast to the cyclic repetition of transference. In order to understand and approach disorders of time perception knowledge of unconscious conflicts and defense processes remains crucial. Even dreams are not timeless. While our conscious mind works according to chronological patterns, the pictorial representation in the particular form of thinking asleep, dreaming, makes it possible to map different memory traces simultaneously. Freud??s speculations about the ??timeless unconscious?? and Nirvana may originate from a longing for redemption. In contrast the author??s final chapter deals with the potential life span and transience of some central psychoanalytic concepts. Not even those who prove to be very close to observation can be attributed with ??eternal life??.     

��ber das Wesen der psychotischen Wahnbildung

The aim of this paper is to explore the nature of the delusional construction so as to render it susceptible to a therapeutic approach. Particular attention is devoted to the nature and structure of delusion and its relation to the healthy part of the personality. In the author??s view, delusion is a psychopathological construction that makes it impossible for the patient to understand his own experience. The delusional construction is similar to a dream-like sensorial production but, unlike a real dream, it remains in the waking memory and creates characters which live independently of the ??dreamer??s?? awareness. It is a dream that never ends. The delusional imagination is so deeply rooted in the patient??s mental functioning that, even after systematic analysis, the delusional world, which had seemed to disappear, re-emerges under new configurations. This paper particularly deals with the difficulty in working through the psychotic episode and in ??deconstructing?? the delusional experience because of the terror connected with it.     

Angststörungen bei Patienten mit implantiertem Kardioverter-Defibrillator (ICD)

Patients with an implantable cardioverter defibrillator (ICD) often show anxiety disorders as comorbid psychologycal disturbances. In a short review we discuss psychosocial aspects of the ICD-implantation. A case study of a 38 year old patient in inpatient treatment is presented for illustration of a cognitive-behavioral treatment method. The psychotherapeutic treatment was carried out in close cooperation with the clinic for cardiology.     

Zur Inanspruchnahme medizinischer Leistungen bei Patienten mit somatoformen Störungen

Zusammenfassung Somatoforme Störungen sind für das Gesundheitssystem sowohl wegen ihrer hohen Prävalenz und auch wegen der intensiven Inanspruchnahme medizinischer Leistungen von großer Bedeutung. Auch bei psychotherapeutischen Interventionen muss dies berücksichtigt werden, da eine Normalisierung des Inanspruchnahmeverhaltens ein zentrales Behandlungsziel sein sollte. In der vorliegenden Studie wurden Häufigkeit ambulanter Arztbesuche und Variablen des Inanspruchnahmeverhaltens untersucht. Insgesamt wurden 295 Allgemeinarztpatienten mit mindestens zwei organisch nicht hinreichend begründbaren Beschwerden in die Studie aufgenommen. Psychische Störungen und die Inanspruchnahme des Versorgungssystems wurden mit einem strukturierten Interview erhoben; daneben wurden zahlreiche Fragebögen eingesetzt. Die Mehrheit (82%) der untersuchten Patienten erfüllte die Kriterien von mindestens einer somatoformen Störung. Die Anzahl der Arztbesuche in den letzten 6 Monaten belief sich im Mittel auf 15 Kontakte. Sie korrelierten mit der Anzahl somatoformer Symptome, dem Alter, Gesundheitsängsten, genereller Angst und Depressivität. Die Regressionsanalyse bestätigt nur die Symptomanzahl und das Alter als signifikante Prädiktoren des Inanspruchnahmeverhaltens. Implikationen für die Therapie dieser Patientengruppe unter besonderer Berücksichtigung des Hausarztes werden diskutiert.     

Deutende Interventionstechniken bei Patienten mit schweren Persönlichkeitsstörungen

The growing influence of ego-psychology, self psychology, object relations theory, and interpersonal concepts on the psychoanalytic psychotherapy of patients with personality disorders is reflected in a preference of relational therapeutic strategies and in a controversial discussion of interpretative techniques. It is shown that interpretative strategies are of invaluable importance in many patients with personality disorders. However, modifications of technique necessary for this group of patients should be considered. Especially, transference interpretation in the here and now can be of great use even in the treatment of patients with severe personality disorders. It is of outstanding relevance for the therapist to understand the interactional message a patients infers from his interpretation and to take into account the patient's reaction to the interpretation.     

Zur Psychoanalyse des Glücks

The article describes some of the foundations of the striving for happiness and the experience of happiness from the point of view of different psychoanalytical theories and applies this to the luck of “Hans in luck” in the fairy tale. While happiness in the drive theory is reached through the gratification of needs, in the theory of narcissism it is defined as a regression to a narcissistic feeling of unity. In object-relations theory it is described how, beside happiness as a mere passive aim of expectation, a capacity to be happy has to be developed progressively.     

Hypnoanalyse – Ein Stiefkind der Psychoanalyse

Goal of this article is to present the manifold methods and techniques of modern hypnotherapy/hypnoanalysis and to show the possibilities for linking them to traditional psychoanalytical methods. In the introduction, clarification of concepts and a short historical overview is given. The phenomenology of the hypnotical state and its assessment from a psychoanalytical and a non-psychoanalytical view either follows. In this connection the topic of meditation is shortly discussed. In the main part a definition of hypnoanalysis is given, the most important hypnoanalytical methods are described and demonstrated by case studies. The question whether psychoanalysis is to be considered as a trance therapy, is also discussed. Free association in hypnotical trance is especially recommended with patients having difficulties to reach their own feelings.