Eine Schlafstörung kommt selten allein

Eine Schlafst?rung kommt selten allein: 67 Prozent der Patienten mit nichtorganischen Schlafst?rungen haben organische Zusatzdiagnosen und 77 Prozent der Patienten mit organischen Schlafst?rungen haben psychiatrische Zusatzdiagnosen (1). Deshalb ist es bei der medikament?sen Behandlung von Schlafst?rungen wichtig, nicht nur den Einfluss verschiedener Medikamente auf die Schlafqualit?t und -architektur zu kennen, sondern auch ihren Einfluss auf die peripheren Schlaf-Variablen hinsichtlich schlafbezogenen Atmungsst?rungen und n?chtlichen Bewegungsst?rungen zu beachten, um nicht mit der Behandlung der einen Schlafst?rung eine andere - koexistente - Schlafst?rung zu verschlechtern und eine Besserung zu verhindern.     

Schlafstörung

A 41 year-old woman presented with restlessness and constricting and pressing dysesthesia in both calves and feet. These symptoms bother her especially in the evening while watching TV and later while lying in bed. She has to stand up repeatedly and walk around in her flat to obtain some temporary relief of her symptoms, which first appeared during her pregnancy 6 years ago and have become gradually worse over time. The patient complains that nowadays she lies awake in bed for up to 2 h until she can go to sleep several times a week. She wakes up 2–3 times a night only to find herself fighting to go back to sleep. During the day she noticed difficulties concentrating during work and frequently reacts angrily towards her husband and her daughter.     

Schlafstörung – Symptom der Depression?

Sleep disorders are an interdisciplinary health issue. Among western industrialized countries, many people suffer from poor quality of sleep. Especially, psychiatric patients have a high prevalence of sleep disorders. The treatment of sleep disorders should follow a detailed sleep history and polysomnographic work-up, which is often not possible in daily work. Thus, patients with sleep disorders are often not treated accurately. Mobile inhospital polysomnography is an attractive alternative that allows tests to be performed already during normal hospitalization on any ward. The following case report shows that the diagnostic work-up of sleep disorders can significantly affect further treatment decisions.     

Eine erfolgreiche Behandlunsgkette bei Zwangsstörung

Obsessive-compulsive disorder (OCD) belongs to a group of disorders with an estimated lifetime prevalence of 2?%, associated with a high socio-economic burden and the risk of chronification. In the latest version of the DSM-5, OCDs were detached from the chapter of anxiety disorders, similar to the ICD-10. Consequently, the fifth revision of the DSM highlights the fact that scientific results so far, like the overactivation of basal-ganglia thalamocortical circuits, basically support a common model for OCDs. Although in the past, OCDs have been ignored as a diagnostic entity, in the DSM-5, the concept of obsessive–compulsive spectrum disorders according to Hollander was partly realized. The present case report outlines an example of a successful therapeutic chain in the treatment of a severe case of OCD with a 90?% reduction of symptoms throughout a calendar-year, emphazising the importance of efficient treatment chains within psychiatric disorders.     

Eine ungewöhnliche Störung der Farben- und Konturwahrnehmung

Ohne Zusammenfassung Bryn Mawr College Mit 2 Textabbildungen.     

Differenzialdiagnose schizoaffektive Störung versus bipolare Störung

This case presentation describes a 22-year-old woman after an episode of psychotic mania. Manic-psychotic and depressive episodes, partially with psychotic symptoms, and different diagnoses have been documented for the past 5 years, raising the question of the differential diagnosis between bipolar disorder and schizoaffective disorder. Depending on the classification (ICD-10 versus DSM-5), schizoaffective disorder is defined differently. According to ICD-10, schizoaffective episodes can be diagnosed when affective and schizophrenic symptoms occur simultaneously. In a different approach, DSM-V requires psychotic symptoms in the absence of major mood episodes for at least 2 weeks in the course of the disorder.     

Narzisstische Persönlichkeitsstörung

Narcissism is a multifaceted term which encompasses traits of normal personality as well as a specific personality disorder. While much research has been concerned with narcissism as a trait there are only few empirical studies on narcissistic personality disorder (NPS). The current diagnostic system of NPS according to DSM-5 (section II) focuses on grandiose narcissism whereas vulnerable narcissism, which is emphasized by clinicians and researchers, has not yet been recognized. While treating NPD patients an increased suicide risk has to be taken into consideration. Psychotherapy of narcissistic patients mainly focuses on processes during patient-therapist interactions, the analysis and processing of grandiose and vulnerable schemas, emotion regulation techniques and a correction of narcissistic behavior in favor of prosocial interactions.     

Schizophrene Denkstörung

Ohne Zusammenfassung     

Generalisierte Angststörung

The core features of generalized anxiety disorder (GAD) are excessive worry about various topics which are perceived as uncontrollable and mostly last for at least 6 months. Worrying is accompanied by a number of symptoms (e.g. muscle tension and irritability). Various etiological models suggest that avoidance of internal processes (e.g. cognitive, emotional, and physical) by worrying is central to the development and maintenance of GAD. Empirically well supported cognitive-behavioral interventions are worry exposure, applied relaxation, treating metacognitions, intolerance of uncertainty and negative problem orientation. Initial studies indicate the efficacy of mindfulness and acceptance-based approaches as well as psychodynamic approaches to treat GAD. The present article reports central diagnostic procedures, important differential diagnoses and illustrates actual (psycho) therapeutic treatment options.     

Posttraumatische Belastungsstörung

There are some problems concerning the concepts of trauma-related disorders and especially the category of posttraumatic stress disorder (PTSD) with respect to classification, diagnosis and epidemiological findings, which can only be understood within the historical framework of the development. Even current diagnostic systems, such as the diagnostic and statistical manual of mental disorders version 4 (DSM-IV) and the international classification of diseases version 10 (ICD-10) differ in the classification of these disorders which led to higher prevalence rates being achieved with ICD-10. The diagnostic algorithms have been opened to included subsyndromal PTSD as well as complex PTSD including more severe psychiatric disorders.     

Die postpartale Bindungsstörung: Eine Risikokonstellation für den Infantizid ?

Background

The effectiveness of preventive approaches in the field of child protection depends, amongst other things, upon identifying typical risk constellations of infanticide. Postpartum bonding disorder, a disorder affecting a mother’s emotional relationship with her child, is one of those risk constellations alongside other negative consequences to child development. It frequently accompanies postpartum depression, which is determined by other emotional qualities. The therapeutic response is a determinant factor for the success of preventive measures.

Method

42 mothers with postpartum disorders (25 depressive, 17 schizophrenic) undergoing treatment at a mother-baby-unit were examined for bonding disorders and the therapeutic response, primarily regarding the mother-child relationship. Perception of bonding, maternal self-efficacy and objectively measured parameters of mother-child interaction were the most important parameters assessed. Results. Nearly 60% of the mothers suffered from a bonding disorder. Overall, the results indicated a clear improvement in psychiatric disorder as well as in the assessed parameters for the mother-child relationship and the experience of motherhood.

Conclusions.

Maternal bonding disorders are strongly associated with postpartum depression and low maternal self-efficacy, which can lead to a risk constellation for infanticide. The data confirm the therapeutic response, thus demonstrating that early diagnosis and treatment of postpartum depression can represent a timely and effective preventive approach in the field of child protection.     

Persönlichkeitsstörung und Intelligenzminderung

There have previously been only few objective investigations on the combined occurrence of intellectual disability and personality disorder. Despite this difficulty, from the current clinical viewpoint there is no doubt that at least people with mild intellectual disability can also develop personality disorders. In slight degrees of intellectual disability it is possible to psychopathologically describe the typical symptoms objectively. For the disorder symptomatic of combined personality disorder in people with an intellectual disability, there are no confirmed facts, publications or diagnostic rules. The diagnostic assignment of behavioral abnormalites as combined personality disorder with dependent and infantile components in people with intellectual diasabilities still does not seem to be justified. In people with medium to severe mental disorders only the comprehensive term “behavioral abnormalities” should be applied.     

Alkoholismus und Selbstzerstörung

First, the development of addiction theory in psychoanalysis is recapitulated on the basis of the works of W.D. Rost and A. Heigl-Evers. For the understanding of alcoholism two concepts are fundamental. The ego-psychological concept postulates addiction as an attempt of a weak ego to help itself, while the object-psychological concept of Rost considers some forms of alcoholism as an expression of unconscious self-destruction.The author of the present article examines on the basis of a case study of autodestructive alcoholism the strength and weak points of the approach of Rost and proposes certain expansions of the model regarding first the object relations of the addict and the counter-transference, where a strong entanglement of the therapist with the destructivity of the patient is obvious. In addition, further considerations about the role of the superego are necessary, which faces the ego with hostility. Finally, the nature of the primary object of the addict person and the nature of the substance as transferential object should be examined. In the case of these inner objects there is a strange mixture of positive and negative aspects having in their consequence a great destructive potential for the person. This constellation bears resemblance to the pathological personality organisation as understood in Kleinian literature.     

Psychotherapie der Panikstörung

Zusammenfassung Bei der Psychotherapie der Panikstörung ist die Wirksamkeit störungsbezogener verhaltenstherapeutischer Ansätze in zahlreichen randomisierten kontrollierten Studien nachgewiesen; für die Wirksamkeit einer störungsbezogenen psychodynamischen Kurzzeitpsychotherapie (panikfokussierte psychodynamische Psychotherapie, PFPP) gibt es erste empirische Belege. Die theoretische Fundierung der therapeutischen Zugänge und die daraus abgeleiteten Behandlungsprinzipien werden für die beiden Therapieverfahren dargestellt; eine aktuelle Übersicht zu empirischen Wirksamkeitsnachweisen wird gegeben: Schulenübergreifend sind Vorgehensweisen wirksam, die die Auseinandersetzung mit der Paniksymptomatik in den Mittelpunkt stellen. Die Verhaltenstherapie erreicht dies mit der Exposition gegenüber panikbezogenen Körpersensationen und -situationen; in der psychodynamischen Psychotherapie hat sich die aktive Exploration panikbezogener Kognitionen und Emotionen sowie die Deutung der für Patienten mit Panikstörungen typischen ambivalent-abhängigen, konfliktvermeidenden Übertragung bewährt. Die mit der Überwindung der habituellen Vermeidung verbundene Stärkung des Selbstwertgefühls wird als wirksamer Faktor diskutiert.