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.     

Veränderungen kriminogener Faktoren bei Sexual- und Gewaltstraftätern in Sozialtherapie und Regelvollzug

In the evaluation of offender treatment programmes, recidivism is still the most common measure of success. However, positive effects concerning future delinquent behaviour do not prove that treatment led to changes in the targeted criminogenic risk factors. Furthermore, little is known about whether such changes differ among the various offender types. This study investigated changes in self-reported criminogenic personality patterns and cognitions in a sample of treated and untreated sexual and violent offenders. Specific prosocial changes in treatment targets, such as self-control, excitability and neuroticism were found but similar improvements were also found in untreated offenders. In addition, changes in measured risk factors did not differ between offender types, although self-control, aggressiveness and neuroticism showed significant interactions between offence type and treatment delivery. Whereas treated violent offenders exhibited more positive changes than untreated violent offenders, an inverse pattern was observed in the case of sex offenders. Minor specific treatment effects as well as the limitations of the administered psychometric instruments are discussed as possible explanations for these results.     

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.     

Evidenzbasierte Diagnostik und Psychotherapie bei Essstörungen

Along with the specific eating-related symptoms, eating disorders are associated with substantial psychological, social and medical sequelae. Overvaluation of body shape and weight and corresponding body dissatisfaction are a central feature of anorexia nervosa (AN) and bulimia nervosa (BN); additionally, these features are also a common symptom in individuals with binge eating disorder (BED). Regarding treatment, cognitive behavioral therapy (CBT) focuses on the distinctive features of the disorder, such as nutritional management and normalization of food intake, alteration of body image disturbances and negative feelings towards one’s body and alteration of the functional relationship between stress, negative emotions and pathological eating behavior. Interpersonal psychotherapy (IPT) instead focuses on the alteration and reduction of interpersonal problems. Following the German S3 guidelines, CBT should be the treatment of choice for BN and BED. Given the scarce empirical evidence of treatment effectiveness for AN, no specific treatment recommendation can be made for AN; however, psychotherapy and not medication should be the treatment of choice.     

Psychotherapie als Weg zum Seelen-Enhancement?

Self-optimization is a widespread trend. Psychotherapists often attempt to psychologically explain self-optimization as a manifestation of narcissism. In reality the fact that self-optimization has become a contemporary imperative is only comprehensible against the background of the individualization of living conditions (Beck). In psychotherapy the boundaries between medical treatment of mental illnesses and enhancement of the psyche are increasingly becoming more flexible. By promising to be able to help on the road to a happier and more productive life, to mental well-being or more life satisfaction, psychotherapy joins the self-optimization chorus. Not all attempts at optimization are limited to wanting to improve those features which are inherent to a person: others, such as the transhumanists want to overcome the imperfections of man via technologically upgrading the human nature.     

Stationäre integrative Psychotherapie bei Multiple Chemical Sensitivity Syndrom

Multiple chemical sensitivity describes a syndrome of unspecific bodily complaints accompanied by the conviction that these are caused by the presence of chemicals in so small doses that normal persons would tolerate them without any problems. On the basis of a single case study of a patient with self reported MCS, we demonstrate the usefulness and necessity of developing an individual approach towards understanding the patients symptom complex. This approach allowed to plan the treatment steps and as a result the patient became symptomless and reached an improved feeling of general well-being in an eight week multimodal inpatient treatment. Factors that could have affected the outcome of the treatment are discussed. The focus of the treatment was the coping with anxiety induced by physical complaints. Change achieved is reflected in the GBB and SCL-90-R scores, the effects of working on interpersonal problems and dysfunctional relationship patterns are demonstrated by the IIP- and the RPQ-data respectively.     

Metaphyfik bei Jordan?

Ohne Zusammenfassung     

Psychopathologische und kognitive Veränderungen unter Rauschdrogen – Relevanz für die strafrechtliche Beurteilung

To properly estimate the effect of drug consumption in the context of criminal responsibility it is important to understand the nature and course of psychopathological alterations whilst under the influence of each particular drug. In addition, it is important to know about the addictive potential of the different street drugs and the pattern of withdrawal symptoms. In this review we are summarizing the existing evidence for the most widely used illegal drugs. We have considered both anecdotal evidence from and systematic surveys within the illegal drug scene as well as the results of experimental research with healthy volunteers. Finally, we evaluate how acute or subacute psychopathological drug effects effect the degree of criminal responsibility.     

Stationäre Kinder- und Jugendpsychiatrie sowie Psychotherapie bei substanzabhängigen Jungen und Mädchen

This study examines post-treatment outcomes (6 and 12 months post-release) of a multimodal child and adolescent psychiatric and psychotherapeutic inpatient treatment program for boys and girls diagnosed with substance use disorders (n=71) in 2 centres. Up to now there has been a lack of outcome research in this field in Germany. Outcome measures included drug use patterns and psychopathology. The greatest reductions in prevalence at 1 year follow-up occurred for cannabis, methamphetamine, cocaine and heroin use. Additionally the patients and their parents also reported significant improvements in adolescent’s psychopathology at the 1 year follow-up. The results underline the importance of disorder-specific, multimodal inpatient programs for the treatment of children and adolescents with substance use disorders.     

Selbstverletzung bei jungen M?dchen

Self-injurious behavior (SIB) occurs frequently, has a peak in adolescence and is reduced in old age. The formation has to be seen multifactorial. Girls with SIB have an unstable self, a lower self-esteem, distorted posture and impaired ability to regulate emotions and the absence of functional coping strategies. With the injury the young girls expect a relaxation and exoneration from the actual conflict. The treatment is multimodal. Recommended are behavioral therapy and behavioral therapy for adolescents (DBT-A). Drug therapy is needed, especially in crises.     

Bedeutung von Stress bei chronischer Ersch?pfung

In this review article a novel approach to the explanation of chronic fatigue is presented. It has long been known that patients suffering from chronic fatigue syndrome (CFS) have reported increased occurrencesof traumatic experiences early in life compared to healthy individuals. Such experiences have been found to substantially impact on biological regulation processes later in life and thus alter sensitivity to stressful stimuli in adulthood. In CFS research has shown that patients display altered endocrine and immune stress regulation. A summary of current research in this area is given and the role of both childhood and adulthood stressors in biological regulation processes in CFS is discussed.     

Zur Altersabh?ngigkeit von Risikovariablen bei Sexualdelinquenz

Based on a sample of 612 male sex offenders, this study examined the latent dimensions of actuarial risk variables, their age-related development and their age-related relevance for the prediction of sexual recidivism within a follow-up period of 5 years. According to the work of Roberts et al. [25] 8 items from Static-99 and Risk Matrix 2000 were examined for their underlying factor structure. The result was a 3-factor solution, which accounted for 63% of the variance and largely replicated the previous findings by Roberts et al. [25]. Following these authors the three scales sexual deviance, dissociality and detachment were calculated from the risk variables and examined in detail. The analysis revealed an increase in sexually deviant personality traits with advancing age of the offenders at the beginning of the follow-up period. No age-related changes were observed in dissocial characteristics. Concerning the detachment scale a negative correlation with the offenders age was apparent. All three risk scales proved to be prognostically relevant in the total sample. On closer examination, however, only sexual deviance showed prognostic relevance in all age groups. In contrast, dissociality was only relevant for the prediction of sexual recidivism in the older offender groups and detachment only in the younger offender groups.