Die Beurteilung der Steuerungsfähigkeit bei psychischen Störungen

Psychiatric assessment of culpability is conducted in two steps: firstly, the psychiatric diagnosis is to be made and attributed to one of the legal terms that entail the requirements for diminished or lack of legal responsibility. Secondly, one has to assess from a psychiatric perspective whether the mentally disturbed suspect who was aware of the unlawfulness of the actions was also able to act in accordance with awareness and to refrain from unlawful actions. The latter is called the capacity for self-control. The ultimately legal normative term of capacity for self-control corresponds to psychobiological concepts of executive and motivational self-control as well as to the psychological models of intentional control of actions (Goschke) and ”disactualization” (Janzarik). These concepts and models are outlined and discussed, particularly with regards to paraphilia and behavioral disorders. In the context of these conditions we sometimes find free-floating considerations about the capacity for self-control without even addressing the question whether the severity of the disorder has crossed the threshold for diminished legal responsibility. The author argues the case for an overall view of the suspect’s personality and abilities, weaknesses and decisions as displayed in the history of the criminal act.     

Psychoedukation bei Personen mit erh?htem Psychoserisiko

Background

So far only few studies are available which have evaluated the effectiveness of psychoeducation for individuals at risk of psychosis in the early initial prodromal state (EIPS) whereas the benefit of psychoeducation in psychotic patients has been repeatedly confirmed. Thus the aim of this study was to investigate the effect of psychoeducation in individuals with increased risk of psychosis in the EIPS.

Method

A total of 128 help-seeking outpatients in the EIPS participated in a randomized controlled multicentre trial of 12 months of either psychoeducation as part of an integrated psychological intervention (IPI) or supportive counseling (SC). The time to transition to psychosis at 12-month and 24-month follow-up as well as the social adjustment at baseline, time of transition or post-treatment by means of the social adjustment scale (SAS?II) were assessed.

Results

The IPI was superior to SC in preventing progression to psychosis at 12-month (3.2% versus 16.9%, p?=0.008) and 24-month follow-up (6.3% versus 20.0%, p?=0.019). Both treatments resulted in significant pre-post improvements in SAS?II with no significant differences between the two groups.

Conclusions

Psychoeducation as part of an integrated intervention is effective for preventing the onset of psychosis over a 24-month time period in people in an EIPS. Moreover patients at risk of developing first episode psychosis seem to benefit from a specific psychoeducational intervention in the context of other treatments as well as from SC.     

Psychologische Interventionen bei Personen mit erhöhtem Psychoserisiko

Indicated prevention in individuals at clinical high risk for first episode psychosis is hoped to delay the onset of the disorder or even prevent the transition to full-blown psychosis. Remission of at-risk symptoms, psychosocial functioning and quality of life are secondary outcomes. According to current evidence cognitive behavioral therapy can be considered the best evaluated stand alone therapy approach for the prevention of psychosis. The treatment of persons at risk for first episode psychosis is associated with the risk of exposing falsely identified persons to potential side effects; therefore, treatment with the best risk-benefit ratio should be chosen. Consequently, monitoring within specialized early recognition centers should be considered first, followed by a customized psychoeducation. The data on psychoeducation of people at risk for psychosis are encouraging but still not sufficient. Methodological issues and differences of the evaluated approaches are discussed.     

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.

     

Musiktherapie bei Kindern mit Migräne

Migraine in childhood is a serious health problem with a tendency for chronification. According to the bio-psycho-social model migraine is considered as a disorder generated by multiple factors and requiring an interdisciplinary treatment concept consisting of both medical and psychotherapeutic interventions. Music therapy as a nonverbal, creative arts therapy is especially apt for the treatment of children. A specific treatment concept in music therapy for children with migraine, to be applied within a multidisciplinary framework, and its theoretical background are presented in this article. Music therapy is firmly established within the context of stationary infant psychiatric care. Also, it is presently used as a method of outpatient psychotherapy mainly for children and adolescents. Additionally, music therapy finds frequent use in medical care, special needs education and curative education for children. This article will be limited to the presentation of music therapy as artistic psychotherapy.     

Qualitätssicherung von Gerichtsgutachten im Familienrecht

In recent years many controversial verdicts and studies have brought discussions about the quality of expert opinions in family law into the focus of the media, political and expert public spheres. With the coalition contract, the ruling parties agreed on improving the quality of expert opinions, especially in the sector of family law, in collaboration with professional institutions. Representatives of the legal, psychological and medical associations, the Federal Bar Association and the Federal Chamber of Psychotherapists worked out guidelines for expert opinions in family law in cooperation with the Federal Ministry of Justice and Consumer Protection. The three main quality assurance aspects are scientifically founded procedures, transparency and traceability. These requirements are concretely illustrated in this article with recommendations concerning the procedure and composition of expert opinions.     

Lärmendes Verhalten und störende Lautäußerungen bei Patienten mit Demenz

Loud behavior and disruptive vocalizations occur relatively frequently in patients with dementia together with agitation and other behavioral problems. An unambiguous diagnosis is important to take targeted therapeutic measures. First, nonpharmacological measures should be tried and the triggering stressors should be identified and eliminated if possible. Guidelines for the treatment of behavioral disorders, thus also for loud behavior, recommend behavioral therapy, cognitive–emotional training, sensory stimulation therapy, and psychosocial interventions. Targeted therapeutic measures can provide relief for the person with dementia and the relatives and nurses.     

Zum Zusammenhang zwischen Vollzugslockerungen, Unterbringung im offenen Vollzug und Legalbewährung bei Sexualstraftätern

Early release, temporary absence, and minimum security confinement have been permitted less often in German prisons in recent years. There are several reasons and indications that sexual offenders are particularly affected by these developments. Prison files and recidivism data of 115 adult sexual offenders who had been in a Lower Saxony prison in the mid-1990s were analyzed for the current study to find out whether this group posed a specific risk when permitted temporary absence or minimum security confinement. It was also considered whether temporary absence and minimum security confinement were related to reduced recidivism after release. The average follow-up interval was 8.5 years. The following findings emerged: First, 50.9% were reconvicted for any offence, 21.3% with an aggressive offence, and only 7.4% were reconvicted with a sexual offence. Every fifth (19.4%) was sentenced to another prison term or had another probation term revoked. Second, rule-breaking and criminal activity by sex offenders during minimum confinement or temporary absence were very rare and of low severity. Third, sexual offenders in minimum security confinement were less likely to recidivate than others on all measures of reoffending. With Cox regression analyses that controlled for important risk factors for recidivism it was found that minimum security confinement contributed to reduced general, but not to reduced sexual or aggressive reoffending. No relationship was found between level of temporary absence status (unaccompanied vs. accompanied) and recidivism. It is concluded that, contrary to public opinion and judicial practice, sexual offenders can be granted minimum security confinement and temporary absence if an adequate selection process is implemented.     

Einsatz von Bupropion bei älteren Patienten

Die chronische bipolare Depression bei ?lteren Menschen ist eine klinische Herausforderung und erfordert unter Umst?nden, wie der vorliegende Fallbericht zeigt, Behandlungswege, die von Leitlinien nicht unbedingt abgedeckt werden.     

Bulimiebehandlung im stationären und teilstationären Setting

While treatment guidelines for outpatient psychotherapy for bulimia nervosa are known, it is hard to find published concepts for inpatient or day clinic settings. We will describe a treatment program developed in Freiburg/Germany, which integrates symptomoriented, cognitive-behavioral elements into a psychodynamic concept. The program presented can be seen as an example. For implementation at other clinics, it should be adapted to their special context and structure.     

Ergebnisqualität von psychotherapeutischen Prozessen mit Jugendlichen

Background

This study investigated the effectiveness of therapeutic processes with adolescents depending on (1) the quality of the therapeutic relationship, (2) generic change indicators and (3) the appearance of specific forms of communication in the initial phase of therapeutic processes. The study concentrated on investigation of the first three initial therapy sessions and was interested in the possible association of these three variables with positive outcomes and in the young patients remaining in therapy.

Material and methods

A total of 20 therapeutic processes, which took place in Santiago de Chile, were examined. Participants were 15 female and 5 male adolescents between 13 and 17 years old and suffering from different psychological disorders. The Chilean version of Horvath’s working alliance inventory, Generic Change Indicators, the Therapeutic Activity Coding System (TACS), Lambert’s outcome questionnaire OQ-45.2 and adherence in terms of completing or not completing therapy were used to assess process and outcome variables.

Results

The three variables measured in the initial phase of therapy with adolescents, i.e. therapeutic alliance, generic change indicators and communicative actions showed a relationship with the therapeutic results in terms of adherence to therapy as well as outcome.

Discussion

The results indicate the necessity of a greater inclusion of the perspective of adolescents in the therapeutic process.

     

Zur Bedeutung des Wahns für die Beurteilung der Schuldfähigkeit nach den §§ 20 und 21 StGB

For the assessment of criminal responsibility of offenders with symptoms of delusion it first has to be examined if one of the four basic elements of §§ 20, 21 of the German Penal Code is fulfilled. For this purpose a careful diagnosis of the type and intensity of the delusion and the underlying psychiatric disease is necessary. If a basic element is fulfilled the effect of the delusion on the ability of the offender to perceive the wrongful character of the act and to control behavior have to be discussed. For this the model of the anthropological cross developed by Winfried Brugger can be helpful.     

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.