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.     

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.     

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.     

Diagnostik der Hypochondrie

In the current review the criteria for the diagnosis of hypochondriasis in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) are compared with the criteria for illness anxiety disorder in DSM-5 and differences are discussed. A current review of instruments for the dimensional assessment of the severity of hypochondriasis and associated characteristics (illness-related cognitions and safety behavior) is given. Possible ways of implementing these instruments for planning and evaluating therapy are specified. Furthermore, economical screening methods, which could be broadly applied in medical contexts to identify patients with pronounced illness anxiety in order to offer effective treatment are described and discussed. This procedure would not only lead to a reduction of strain in the person concerned, it would also be connected with financial relief for the health care system.     

Neue Entwicklungen in der allgemeinen psychoanalytischen Psychosomatik

Psychoanalysis has played a pivotal role for developments in psychosomatics both on a conceptual and an institutionalization level. In contemporary psychosomatics there is a focus on conceptual models that concentrate on psychic structure, the processing of emotions and embodiment. Alongside these, the questions arise on how psychoanalytic views on psychosomatic disorders in a more classical sense will develop further and their relevance for current developments. This article gives a brief historical overview of some central concepts in psychoanalytic psychosomatics and shows how these are resumed in what can be distinguished as six aspects of contemporary psychoanalytic psychosomatics. This is demonstrated by a brief case report. The article closes with some proposals for the clinical practice.     

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.     

Neue soziometrische Perspektiven

Zusammenfassung Die Hypothese, daß ein Zusammenhang besteht zwischen dem soziometrischen Wahlverhalten und einem oder mehreren Faktoren der Trias Valenz, Potenz und Erregung, konnte korrelationsstatistisch bestätigt werden. Es zeigte sich, daß die typischen soziometrischen Wahlfragen weitgehend einfaktoriell — valenzkorreliert — sind. Daneben spielt aber für bestimmte Fragen (z.B. Führerwahl) auch die Potenzdimension eine entscheidende Rolle. Die 21 in diesem Versuch verwendeten Kriterium-Fragen, unter denen sich auch soziale Meinungs-, Einstellungs- und Personwahrnehmungsfragen befanden, zeigten mit ihren Valenz-Potenz-Korrelationen eine gemeinsame funktionale Bezugsgrundlage.Das Eindrucksdifferential erwies sich als geeignetes Instrument, eine soziale Gruppe und ihre Angehörigen hinsichtlich ihrer Eigenschaften als Objekte und Subjekte sozialer Beziehungen zu kennzeichnen. Die Daten des Eindrucksdifferentials lassen eine objektive Strukturanalyse der Gruppe mit Hilfe der D-Faktormethode zu. Die Vorzüge der Methode sind zahlreich, so daß man gern bereit sein wird, ihre wenigen Nachteile (vor allem zeitlichen Aufwand) mit in Kauf zu nehmen, wenn es die Umstände erlauben. Die klassische soziometrische Methode der Vorzugswahlen wird jedoch bei jüngeren Kindern nicht durch die Differentialmethode zu ersetzen sein.

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Summary The hypothesis that sociometric choice behavior is intimately related to one or several factors of the factorial trias Valenz (evaluation), Potenz (potency) und Erregung (activity) was supported by this correlational study. It has been shown that the standard sociometric questions are correlated with Valenz. Certain other questions (leader choice questions e.g.) are further correlated with Potenz. Most of the 21 questions of a criterion questionnaire applied in this study, among them opinion, attitude and person perception items, proved to have a common functional frame of reference defined by the Valenz and Potenz coordinates.The differential method was shown to be a suitable instrument to analyze small groups and their members in terms of their intragroup relations. The data obtained by this method permit an objective subgroup analysis by the D-method of factorization. Unfortunately the procedure of differential scaling is more time consuming. But the advantages are numerous and prevail over the disadvantages. The classical sociometric test might remain the only applicable method in studies with younger children.

     

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.      

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.     

Das Leben der Wildente in der Zeit der Paarung

Ohne Zusammenfassung     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.