Diagnostik in der Verhaltenstherapie

After an introduction, a short historical review of the development of behaviour therapy and the importance of categorical classification of mental disorders is given. We present different assessment approaches that are important in behaviour therapy. They comprise anamnesis, categorical classification, somatic differential diagnosis, psychometric methods, ratings scales, and diaries. As the core assessment strategy in cognitive behaviour therapy, functional behavioural analysis is introduced in detail, in which methods of horizontal analysis of behaviour (SORKC model proposed by Kanfer) and the vertical analysis of behaviour are explained. The importance of computer-based assessment and specific approaches of assessment within behaviour therapy for children and adolescents are presented. By way of conclusion, the prospects of possible new developments of assessment in behaviour therapy are outlined.     

Symptomattributionsstile bei Hypochondrie

Background

Somatic symptom attributions are of central importance in cognitive-behavioral models of the development, maintenance and treatment of hypochondriasis. However, the mode of symptom attribution has rarely been systematically investigated in these patients. Is a somatic mode of symptom attribution indeed specific for hypochondriasis and furthermore, how strongly is it associated with “doctor shopping”, a typical behavioral consequence of hypochondriasis?

Patients and methods

In this study 88 hypochondriacal, 52 depressive and 52 healthy persons were asked to complete the symptom interpretations questionnaire and several standardized symptom questionnaires. They also took part in two structured clinical interviews for the diagnosis of hypochondriasis and various other psychological disorders according to DSM-IV.

Results

Somatic symptom attributions were associated specifically with hypochondriasis, while normalizing attributions characterized persons with low health anxiety. When examined as predictors in multiple regression models, in particular somatic attributions and the total of somatoform complaints predicted the intensity of health anxiety (R ²?=?0.69) and “doctor shopping” (R ²?=?0.48).

Conclusion

In the cognitive-behavioral treatment of hypochondriasis, patients should be encouraged to test normalizing explanations as alternatives to habitual somatic attributions of somatic disturbances.     

Diagnostik in der Psychotherapie

Diagnostic approaches in psychotherapy are accompanied by a continuous and unchanged discussion concerning fundamental questions. Because of its many functions diagnostics in psychotherapy has to take psychiatric, psychological, orientation-specific models and methods of assessment into consideration. Following the publication of the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) the increasing danger of a further increase in the number of psychiatric disorders is evident. In this article the principles of current psychiatric diagnostics and psychodynamic psychotherapy are presented and discussed. Furthermore, the dangers associated with the increased medicalization and over-diagnosis are highlighted. Against this background consideration is given to the risks for patients and societal aspects.     

Diagnostik in der Psychotherapie

The present paper gives an overview of criteria and methods of diagnostics and assessment in psychotherapy from an orientation-unspecific point of view. First, some general remarks on the aims and strategies of psychotherapeutic assessment are made as well as specific functions during the different phases of a treatment are explicated. Because of its many functions diagnostics in psychotherapy has to take into consideration psychiatric, psychological and orientation-specific models and methods of assessment. At the beginning of a treatment problem-analysis and therapy-planning are needed, during its course the processes and changes are to be studied and at the end of the treatment its outcomes are to be evaluated. Diagnostic assessments are also important for monitoring and controlling the quality of the process and the outcome of a psychotherapy. At the end of the paper some general criteria for the application of assessment in psychotherapy are formulated.     

Neue Felder in der Operationalisierten Psychodynamischen Diagnostik

After the operationalized psychodynamic diagnostics (OPD) system became well established in clinical as well as research contexts, especially in German speaking countries, the OPD task force now focuses on issues, such as modules and new manuals which are related to various clinical contexts. In this article new modules and manuals are presented and discussed in summarized form: the modules for addiction disorders and for forensic patients, the new OPD-2 manual for children and adolescents, an OPD-based manual for formulating initial assessment reports for insurance companies as well as a conceptualization for an operationalized psychodynamic therapy (OPT).     

Konflikt- und Strukturachse der Operationalisierten Psychodynamischen Diagnostik des Kindes- und Jugendalters

This paper presents the advantages of a comprehensive Operationalized Psychodynamic Diagnostic in childhood and adolescence (OPD-CA) for subsequent treatment planning. Information about the conflict and structural axes as a function of age, gender, diagnosis and proposed form of treatment (outpatient/inpatient) was analyzed in a group of 116 patients. Independent from the diagnosis, a similar ranking in the importance of conflicts was found. Self-esteem conflicts were more prominent for inpatient children and adolescents and identity conflicts were more prevalent in children and adolescents who were at the start of outpatient therapy. Patients with an indication for inpatient treatment had a significantly lower level in all structural dimensions. This study analyzes the reasons for these findings.     

Psychodynamische Diagnostik

The paper describes the development and objectives of psychoanalytic diagnostics. It shows that one of the key tasks of psychoanalytic/psychodynamic interviews is to initiate the doctor-patient relationship and that the patient’s motivation for treatment is to be examined and promoted in the interview. Different sources of information for the interview are then described; following a presentation of various systematic approaches of psychodynamic diagnostics, the principles of biographic history-taking are also explained. Modern psychodynamic diagnostics provides complex access to the patient, covering both elements of open interviewing and more exploratory approaches. Options for integrating these various methodological approaches are highlighted. Finally, more recent approaches in psychodynamic diagnostics that have a stronger relation to treatment planning are presented. These include the Structural Interview developed by Kernberg and Operationalised Psychodynamic Diagnostics (OPD).     

Beurteilungsgrundlagen psychodynamischer Diagnostik

In the period of 1988–1999 752 anamnestic reports made by psychoanalysts-in-training on the basis of initial interviews with treatment seeking patients were examined concerning their psychodynamical judgement criteria. The study was conducded at the Institut für Psychotherapie e.V. in Berlin. Trained raters analysed first the presented “psychodynamic considerations” concerning their implicit theoretical and clinical concepts and second the supervising analysts commentaries. Moreover, the supervising analysts were asked to explicate their own theoretical orientation. The findings were then put in comparison. In the course of the study, changes over time in preferences for some concepts and diagnoses were observable. Psychoanalysts-in-training differ from experienced psychoanalysts in their preferred data sources, and men and women differ in their diagnoses. Concerning their theoretical orientation, psychoanalysts-in-training lean on their instructors.     

Kultursensible Diagnostik in Forschung und Praxis

Nearly one fifth of the German population are migrants of the first and second generation. Evidence-based knowledge about mental health of migrants, their health care needs and the actual mental health care situation of this population is limited. Psychometric instruments are helpful for the assessment of mental disorders. Although a culture-sensitive approach in diagnostics is necessary it is often neglected in research as well as in clinical practice. This article describes culture-specific and linguistic challenges and specifies specific communication problems. In most cases psychometric instruments are not developed simultaneously in different languages but are translated later on. After translation psychometric instruments should be culturally validated and adapted with respect to linguistic, cultural and metric equivalence. The article gives an overview about the different aspects of equivalence and explains these aspects on the example of the PHQ-9.     

Epilepsie: Aktuelles zu Diagnostik und Therapie

Bei etwa 65 Prozent der Epilepsiepatienten kann durch eine antikonvulsive Therapie anhaltende Anfallsfreiheit erreicht werden, bei den übrigen 35 Prozent entwickelt sich eine therapieresistente beziehungsweise schwer behandelbare Epilepsie. Für manche Patienten mit therapieresistenten Epilepsien stellt die Epilepsiechirurgie eine effektive und sichere Behandlungsoption dar. Die wichtigsten Behandlungsziele sind neben der optimalen Anfallskontrolle (im Idealfall Anfallsfreiheit) die gute Vertr?glichkeit der medikament?sen Therapie, die Vermeidung von chronischen Nebenwirkungen, die einfache Handhabung der Medikation für Arzt und Patient, die günstige Beeinflussung von mit der Epilepsie h?ufig assoziierten Begleiterkrankungen sowie die Berücksichtigung der Bedürfnisse spezieller Patientengruppen. Generell sollte somit eine m?glichst individualisierte Therapie erfolgen, die auf die Bedürfnisse des jeweiligen Patienten abgestimmt ist.     

Operationalisierte Psychodynamische Diagnostik des Kindes- und Jugendalters

There are only a few studies focusing on the mental structure and its change in children and adolescents with psychiatric disorders. This study aimed at investigating change in the mental structure of children and adolescents over time. At intake 60 inpatients were interviewed with the operationalized psychodynamic diagnostic interview for children and adolescents (OPD-CA). After an average of 27 months 25 patients agreed on participating in the follow-up study. The OPD-CA was conducted again and the Kiddie-Sads present and lifetime version (Kiddie-Sads-PL) as well as parent-based ratings child behaviour checklist (CBCL) and strength and difficulties questionnaire (SDQ) were applied. A consensus rating of the OPD-CA was attained by three researchers well experienced with the use of the OPD-CA. The level of structural integration improved significantly, in particular in the dimensions “control” and “communication skills”. There were no significant changes in the dimension “self-perception/object-perception”. The improvement was also observable in parent-report questionnaires. This study makes a contribution to the idea that changes in the mental structure of children and adolescents can be shown and measured with the OPD-CA.     

Dokumentation ambulanter Diagnostik in psychosomatischer Medizin und Psychotherapie

Zusammenfassung Das vorgestellte Dokumentationssystem vereint in sich die folgenden Anforderungen: Die zeitökonomische Abbildung der aktuellen Befunde, die Visualisierung der Biographie bzw. Lerngeschichte, die strukturierte Erfassung der Operationalisierten Psychodynamischen Diagnostik (OPD), die psychische und somatische Diagnostik einschließlich Rating des Beeinträchtigungsschwere-Score (BSS) und der Global Assessment of Functioning Scale (GAF) sowie die psychotherapeutisch-psychiatrischen Vorbefunde und die abschließende Indikationsstellung. Lediglich der Arztbrief, der beispielhaft dargestellt wird, wird diktiert. Eine so strukturierte Dokumentation ist patientennah, zeitökonomisch und bewährt sich an den Schnittstellen einer ambulant-stationär-ambulanten Behandlungskette. Sie ist eine ideale Basis für ein Qualitätsmanagement sowie Evaluation in der niedergelassenen Praxis, Ambulanz sowie im Konsiliardienst.