Spezielle Aspekte bei Angststörungen

Anxiety disorders are among the most common mental health conditions worldwide and frequently cause significant functional impairment. Generalized anxiety disorder is the most commonly occurring impairing anxiety disorder in primary care. The degree of disability attributable to generalized anxiety disorder is comparable to that of major depression and is similar to that of chronic physical illnesses, such as peptic ulceration, arthritis, asthma and diabetes mellitus. Comorbid illnesses, such as mood disorders are commonly seen in clinical practice and have a significant impact on the clinical presentation and the treatment approach. Both psychotherapeutic and pharmacological techniques are recognized as being effective management strategies. The present article focuses on two case-reports of patients with anxiety disorders in an inpatient setting. By describing comorbid conditions subsequent difficulties and challenges in treatment are underlined.     

Videotherapie bei postpartalen Störungen

Video recording is currently part of in- and out-patient therapy programs for parents with infants. The observation and analysis of video sequences allow the patient to gain an extraordinary insight with respect to its own experience and behaviour. Video Microanalytical Therapy (VMT) looks for the mother’s positive qualities in her relationship to the child and employs these qualities in order to support successful interactions. VMT is well-suited to the treatment of mothers with postpartal affective or psychotic disorders, because the typical cognitive distortions and reduced perception shown by these mothers can be avoided to a large extent through the use of pictures. In this study, a video microanalytical therapy concept will be presented, that was developed for the treatment of postpartally disordered mothers at the Psychiatric Centre Nordbaden in Wiesloch, Germany.     

Verhaltenstherapie bei dissoziativen Störungen

Zusammenfassung Epidemiologische Daten bezüglich dissoziativer Auffälligkeiten werden vorgestellt. Diagnostizierbare dissoziative Störungen werden im Bereich des pathologischen Pols eines Kontinuums dissoziativer Phänomene eingeordnet. Ausgehend von der allen dissoziativen Störungen gemeinsamen Kernsymptomatik der strukturierten Separation mentaler Prozesse aus der ganzheitlichen Wahrnehmung wird ein universelles Ätiologiemodell dieser Erkrankungen dargestellt. Es basiert im Wesentlichen auf neueren Erkenntnissen der Neurobiologie und Gedächtnisforschung und bezieht sich auf die Traumatisierung als zentralem pathologenetischem Agens. Hiervon ausgehend, wird ein 2-phasiges Therapiemodell vorgestellt. Als Ziel wird ein Aussetzen bzw. eine Reduktion der dissoziativen Symptome über eine Integration der traumatischen Erfahrungen angestrebt. Die beschriebenen therapeutischen Vorgehensweisen sind grundsätzlich bei allen traumatisch bedingten dissoziativen Störungen anwendbar. Auf Konversionssymptome sowie die dissoziative Identitätsstörung wird als Sonderfälle separat eingegangen.Der Text basiert auf dem gleichnamigen Vortrag, den die Autorin am 24.10.2003 auf dem 5. Wissenschaftlichen Kongress der Deutschen Ärztlichen Gesellschaft für Verhaltenstherapie in Bad Pyrmont gehalten hat.     

Zahnhartsubstanzschäden bei Essstörungen

Eating disorders such as anorexia nervosa and bulimia nervosa lead to several serious physical problems. One possible consequence is acid-related dental erosion. Dental erosion can be identified early and is caused by exogenic (selection of food) and / or endogenic (gastric acid) factors. That is why dentists play an important role in the early identification of eating disorders as well as in the prevention and therapy of dental erosion. They should be important collaborators of psychotherapists. We review characteristic damages to the teeth that are seen in eating disorders as well as preventive and therapeutic interventions. Psychotherapists should be informed about dental problems and preventive strategies to educate their patients.     

Psychische Störungen bei HIV-Infektion und Aids

The human immunodeficiency virus (HIV) is the pathogen responsible for acquired immune deficiency syndrome (AIDS). Worldwide there are currently about 40 million people infected with HIV and an estimated 44,000 in Germany. If left untreated after a few years the infection leads to the manifestation of AIDS and eventually to death through opportunistic infections and malignant tumors. Infection with HIV is not curable. Nevertheless, antiretroviral treatment can slow the progress of the disease and prolong life expectancy significantly. Once antiretroviral treatment has started the medication must be taken regularly and lifelong. Serious side effects of the medication pose a significant stress on physical and psychological well-being and impair adherence. Infection with HIV means a total change in life perspectives and requires extensive adaptations in lifestyle. Problems with adaptation and mental disorders (e.g. depression, anxiety disorders, adjustment disorder) are, therefore, frequent. With disease progression neurocognitive impairments are increasingly likely. Mental disorders and neurocognitive impairments adversely affect treatment adherence, increase health risk behavior and reduce immune function. Psychological interventions contribute significantly to the reduction in health risk behavior, improve treatment adherence and are successful in the treatment of depression and anxiety.     

Systemische Therapie bei Störungen des Erwachsenenalters

Background

Systemic therapy is a scientifically acknowledged form of psychotherapy in the US and many European countries, but not yet in Germany.

Method

All randomized (or parallelized) controlled trials (RCT) evaluating systemic couples/family/individual therapy with adult index patients published in English, German or Spanish up to the end of 2004 were identified via data base searches and cross-references in other meta-analyses and reviews. A meta-analysis of the identified RCT was performed.

Results

28 RCT (43 publications) evaluating systemic therapy with adult index patients suffering from clinical disorders (ICD-10) were identified. Systemic therapy is efficacious with regard to substance disorders, mental/social factors interacting with somatic disorders, schizophrenia, depression and eating disorders. The results are stable across follow-up periods of up to 5 years.

Conclusion

According to the criteria of the German Scientific Advisory Board Psychotherapy (Wissenschaftlicher Beirat Psychotherapie) there seems to be good evidence for the efficacy of systemic therapy in at least four fields of application of adult psychotherapy.     

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.     

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.     

Affektverarbeitung und Beziehungsgestaltung bei somatoformen Störungen

Somatoform disorders are usually associated with disturbances in affective processing and consequently with relational disorders. The effect of psychotherapy on the emotional regulation and the relational behaviour in the course of treatment of a patient with somatoform autonomous dysfunction and dysthymia has been examined. Pre-post comparisons of inpatient treatment have been performed by means of standardized questionnaire data; the course of therapy has been evaluated by the analysis of the dependence of the leading symptom of hypogastric pain on mood parameters with the help of multivariate time-series analyses. One effect of psychotherapy was the initiation of an intrapsychic discourse, which led to an improved ability of affect regulation as well as to a better functioning in relationships. This was accompanied by a reduction of somatization. The interrelations between somatization, affect- and relationship-regulation are discussed.     

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.     

Primärprävention bei Essstörungen

Zusammenfassung Essstörungen gelten als schwer therapierbar. Mit einer Mortalitätsrate von 5–16% ist Magersucht die schwerste psychosomatische Erkrankung bei Mädchen und jungen Frauen. In den letzten Jahren wurde daher verstärkt versucht, der Entstehung von Essstörungen durch präventive Maßnahmen entgegenzuwirken. Der Schwerpunkt liegt hierbei auf der Primärprävention im Rahmen von Schulprojekten. Hierfür liegen bereits ermutigende Wirkungs- und Qualitätsnachweise vor. Entsprechende Projekte stehen im Zentrum der vorliegenden Übersichtsarbeit. Diese stellt keinen Anspruch auf vollständige Darstellung, sondern ist ein Versuch der Systematisierung unterschiedlicher Herangehensweisen und soll durch die kurze Beschreibung möglichst prototypischer und evaluierter Beispiele einen Einblick in die derzeitige Praxis der Primärprävention von Essstörungen geben. Quellen der Übersicht sind die Datenbank der Bundeszentrale für gesundheitliche Aufklärung (BZgA), Veröffentlichungen in Fachzeitschriften sowie Internetauftritte. Da Art, Umfang und Umsetzung der Präventionsprogramme sehr von politischen Bedingungen und Voraussetzungen innerhalb des Gesundheits- und Bildungssystems abhängen, bleibt die Übersicht auf Programme aus dem deutschen Sprachraum beschränkt.     

Prävention seelischer Störungen bei Kindern

During the last years psychosocial prevention became more and more established. The need for a focus on “early intervention” is a consequence of scientific research on the effects of psychosocial stress in infant development. Mental and neural development in the infant years is very modifiable, thus primary prevention has to centre on advancements in the immediate conditions of maturation. This is exceedingly important for children in families at risk. This article gives an overview of actual preventive measures, especially of those in the German-speaking countries.     

Verhaltenstherapie bei Kindern und Jugendlichen mit Angststörungen

Research into anxiety disorders of children and adolescents have been neglected for a long time. Current work on the prevalence and on the course of anxiety disorders of children and adolescents impressively substantiates that (1) anxiety disturbances are the most frequent mental disorders of children and adolescents and, (2) represent important factors of risk for the development of anxiety disorders, depression and substance dependence/abuse in adulthood. The recent developments in behavior therapy on anxiety disorders with children and adolescents are presented first and the results of a meta-analysis of behavior therapy studies are summarized. The results of the meta-analysis show that anxiety disorders can be treated successfully in children and adolescents with behavior therapy. The follow up data show that therapy successes remain stable over a timespan of several years. In comparison of individual and group therapy as well as child and family-based therapy, there are no important differences with regard to therapy success.     

Traumafolgestörungen bei Erwachsenen, Kindern und Jugendlichen

Valid diagnostics are an essential foundation of a successful psychotherapeutic treatment. For posttraumatic stress disorders this is not always the case, i.e. when questionnaires are applied that do not completely comply with the criteria of a posttraumatic stress disorder according to the classification systems DSM-IV and ICD-10. In the present review, trauma questionnaires frequently applied in German-speaking areas for adults, children and adolescents are presented with their specificities and are critically discussed. Finally, recommendations for diagnosing posttraumatic stress disorders by means of questionnaires are made.