Sekundäre Traumatisierung

During the past several years there has been a growing interest in the negative effects that therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. As yet it has not been verified that secondary traumatization consists of posttraumatic symptoms and leads to clinically significant distress. In an exploratory study 21 therapists were interviewed who declared that they had experienced an incident of this form of work-related stress. The presented study reveals that in fact such a ?vicarious“ traumatization can arise, even without direct contact to the original trauma. It consists of post-traumatic stress disorder (PTSD)-like symptoms, but in severe cases it can also manifest itself in symptoms which are far beyond the typical PTSD spectrum. Conditions for the development of secondary traumatization are high empathic ability and dissociative processing of the trauma material by the therapist.     

Stationäre oder teilstationäre Psychotherapie?

In a pilot study we compared two groups, one of inpatients and one of day clinic patients who were treated between January 1999 and December 2001 at the Department of Psychosomatics and Psychotherapeutic Medicine in Freiburg/Germany. Both settings offer a similar, multimodal and intensive psychotherapy program on a psychodynamic background. In a first explorative data analysis (sociodemographic data, SCL-90-R, IIP-C) we studied differences in severity of initial symptomatology and differences in outcome (prae/post). Patients with anorexia nervosa and a very low weight were preferentially treated in the inpatient setting. In addition the inpatient group of patients with a somatoform disorder showed higher degrees of somatization, as compared to patients with a somatoform disorder in the day clinic. Therapeutic change with respect to psychopathology however did not differ between the two settings: both groups showed a significant improvement during the course of therapy.     

Teilstationäre Psychotherapie

Psychotherapeutic day clinics increasingly take over responsibility for the treatment of patients who cannot be cared for satisfactorily, respectively, at all in an inpatient setting. Psychotherapy in a day clinic setting is a treatment in its own right which has progressively established itself between inpatient and outpatient treatment. Empirically raised up to date data prove the efficacy and the efficiency of psychotherapeutic treatment in day clinics. Accordingly, the goal of the present study is to investigate the outcomes of psychotherapeutic treatment in a day clinic with a psychodynamic concept. Since 1996 the psychotherapeutic day clinic Basel empirically assesses the treatment course of all admitted patients. Patients and therapists fill in questionnaires upon admittance, two months into the course of treatment and upon discharge (SCL-90-R, PSKB-Se-R, OPD etc.) Our results indicate that significant improvements of symptoms as well as of socio-communicative competency can be achieved during treatment which remain stable even after discharge (first follow-up three months after discharge). Comparing outcome data of patients treated in full-time inpatient setting and of patients who undergo partial hospitalization we found that outcome was at least equivalent. Additionally we found that the diagnosis of a personality disorder influenced treatment results significantly in some symptom specific spheres.     

Evolutionäre Psychiatrie

In contrast to mainstream psychiatry which mainly focuses on the proximate causes of human behavior, evolutionary psychiatry tries to elucidate the ultimate causes of the systems involved in generating specific behavioral patterns. Thus, it is in contradiction to the tabula-rasa model commonly used in social sciences. Using this explanatory approach, it is shown that behavioral sciences like human ethology initiated by K. Lorenz and I. Eibl-Eibesfeldt provide an important scientific basis for modern psychiatry.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.     

Primär- und Sekundärprozess bei Angst und Depressivität im psychoanalytischen Erstinterview

Zusammenfassung Vorgestellt wird eine quantitative inhaltsanalytische Untersuchung an 46 psychoanalytischen Erstinterviews, die mit Angstpatienten und depressiven Patienten in Düsseldorf und Magdeburg geführt wurden. Im Mittelpunkt der Methodik steht das Regressive Imagery Dictionary (RID), ein computergestütztes Verfahren mit 43 Einzelkategorien, die zu den drei Indikatoren primärprozesshafter Inhalt, sekundärprozesshafter Inhalt und Emotionalität zusammengefasst werden. Die durchgeführten Subgruppenvergleiche beziehen sich auf Unterschiede zwischen Angstpatienten und depressiven Patienten sowie ostdeutschen (Magdeburg) und westdeutschen (Düsseldorf) Patienten. Die Ergebnisse zeigen in den Texten der ostdeutschen Patienten ein höheres Maß an primärprozesshaften Inhalten, insbesondere in den Kategorien Passivität und regressive Kognition. Bezüglich der Diagnosegruppen zeigen die Angstpatienten gegenüber den depressiven Patienten ein höheres Maß an primärprozesshaften Inhalten in der Subkategorie Oralität. Es zeigt sich, dass in psychoanalytischen Interviews nicht nur diagnosespezifische Inhalte thematisiert werden, sondern auch kultureller Hintergrund, Geschlecht und Bildung von Bedeutung sind. Die Studie leistet einen Beitrag zur Identifizierung automatisch erfassbarer Textmerkmale, die charakteristisch für die in einer qualitativen Studie gefundenen idealtypischen nosologischen Konstrukte der neurotischen Depression und der phobisch-angstneurotischen Erkrankung sind. Hierbei ist der depressive Idealtypus durch eine Überidentifikation mit Werten, durch das Gefühl der Abhängigkeit von einer schädigenden Person, durch Selbstwertprobleme, Hemmung und den unerfüllten Wunsch, geliebt zu werden, gekennzeichnet. Der Angsttypus zeichnet sich durch ein klischeehaft positives Bild der eigenen Persönlichkeit aus sowie durch die Gefühle, falsch verstanden, ausgenutzt, nicht ernst genommen und zum Außenseiter gemacht zu werden, sodass er bei nachlassenden Kräften im Kampf um Leistung nicht mehr mithalten kann.

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Primary and secondary processes in psychoanalytic first interviews with patients suffering from anxiety and depressionA regressive imagery dictionary content analysis study in West and East German patients

The present paper describes a study on the intake interview narratives of psychotherapy patients with computer assisted content analysis methods. 46 psychoanalytic first interviews of patients suffering from depression or anxiety disorders were analysed with the Regressive Imagery Dictionary (RID), a computer assisted content analysis method with 43 subcategories, which were sumed up to three main categories: Primary Process, Secondary Process, and Emotion. Comparisons between different subgroups of this sample were made: Anxiety vs. depressive patients, and East Germans (Magdeburg) vs. West Germans (Düsseldorf). Significant correlations were found between the Primary Process subcategories Passivity and Regressive Cognition, and East German patients, as well as correlations between the Primary Process subcategory Orality, and anxiety patients. The results confirm our hypothesis, that the psychotherapist-patient-interaction sequences, which are the basis of diagnostic categorization, enclose as well elements which are specific for the disorders under study as elements which are specific for sex and culture (east vs. west). The study contributes to the identification of specific text markers, which can be found in the narratives of patients suffering from neurotic depression vs. patients with phobia and panic disorders. The results of the study are compared with a previous qualitative study. Using the ideal-type concept, our qualitative content analysis study showed as characteristic features of depressed patients overidentification with social roles and norms, feeling of being dependent and injured by another person, problems of self-esteem, shyness, and unfulfilled wishes to be loved and accepted. In contrast, phobic patients characterized the own personality as normal and without any problems in a stereotype way, at the same time feeling misunderstood and exploited by other persons, feeling as an outsider and left alone, and being no more able to compete with others.

     

Endovaskuläre Therapie des akuten ischämischen Schlaganfalls

Endovascular therapy of acute ischemic stroke represents a supplementary or (in cases of contraindications to systemic lysis) alternative therapy option to intravenous thrombolysis for patients with severe clinical deficits and proximal vascular obstruction. Currently, (in cases with no contraindications to systemic lysis) the combination with mechanical thrombectomy in the form of so-called stent retrievers has proven to be effective and safe. Until superiority over intravenous thrombolysis alone has been proven in certain patient groups, patients who have received endovascular therapy should be carefully documented in register-based studies.     

Wiederkehrende,primäre Kopfschmerzen im Jugendalter

Background

Recurrent pain, especially primary headache, is a serious health problem in adolescents. Music therapy in the treatment of children with migraine has already been evaluated. The aim of this pilot study was to adopt this treatment manual for adolescent patients with recurrent primary headache in preparation for the main randomized controlled trial.

Patients and methods

In this pilot study two different modes of treatment (standard and compact treatment) were tested in an outpatient setting with 19 patients. Frequency and intensity of headache symptoms were evaluated using pain diaries for 8 weeks in a pre-post design.

Results

The pilot study showed good feasibility of both treatment conditions in outpatient practice. Patients reported a reduction of pain frequency and intensity in both groups. The evaluation of the clinical relevance of these effects remains the objective for the main trial.

Conclusions

The music therapeutic treatment plan for children with migraine is even feasible in the treatment of adolescents with recurrent, primary headache. Further evidence questioning the effectiveness of the treatment under controlled conditions is needed.

     

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.     

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.     

Kriminologie als interdisziplinäre Wissenschaft – Situation und Perspektiven

In Germany, criminology has become established primarily in law faculties; however, it must currently face cutback tendencies which have to be attributed, among others, to the minority position of criminologists in the respective faculties. These tendencies must be countered with regard to the importance of criminology as a science which deals with central social problems. Criminology must become embedded in jurisprudence and in the psychological, psychiatric and social sciences. Interdisciplinary criminological research centers could be established. A close cooperation between criminology and forensic psychiatry is recommended in many areas.     

Adornos und Derridas Husserllektüre: ein Annäherungsversuch

Ohne Zusammenfassung