Zur Prävalenz von Depersonalisation und Derealisation in der stationären Psychotherapie

Depersonalization (DP) and derealization (DR) remain poorly recognized in clinical routine. Active exploration through structured interviews is strongly recommended, because patients rarely describe spontaneously their experiences with DP/DR. 143 psychosomatic, first-admission inpatients were interviewed about the 1-month prevalence of DP/DR using the Structured Clinical Interview for DSM-IV dissociative disorders. Additionally, the German questionnaires of the Cambridge Depersonalization Scale, the Dissociative Experiences Scale, the SCL-90-R and the Inventory of Interpersonal Problems were used. In the sample we found a prevalence of 23.1% (N=33) for depersonalization-derealization syndrom (ICD-10 F48.1) and 7% (N=10) for secondary pathological DP/DR. A total percentage of 62.9% reported DP/DR to some degree or other. There was a noticeably high co-occurrence of anxiety disorders in patients with pathological DP/DR. Patients with pathological DP/DR were generally more impaired, suffered many more interpersonal problems and were particularly characterized by introversion. Considering the high prevalence of this phenomenon, more attention should be paid to DP/DR in routine diagnostic procedures, treatment and research.     

Prävention in der Arbeitswelt

In the new working world with its growing turbulences and increasing demands prevention is getting more difficult but at the same time increasingly necessary. New forms of working and of organization, the vanishing limits between work and private life and the promotion of patchwork patterns in both areas call for adequately differentiated prevention concepts. People have to be beside the enhancement of their qualification (performance enhancement) prepared for the future in their effectiveness and health (social competence, employability) as the individual aspect. The situation and the organization (structure) have to be preventively shaped in a way, that the desired interactions in the field of performance, health, security and life quality may be experienced. A blueprint for this purposes is presented here accompanied by practical instruments and propositions for prevention as for example bonification.     

Prävention

Ohne Zusammenfassung     

Beziehungsorientierte Prävention und Intervention in der frühen Kindheit

Zusammenfassung Präventions- und Interventionsansätze in der frühen Kindheit messen der Beziehung zwischen Eltern und Kind entscheidende Bedeutung bei. Forschungsbefunde, insbesondere aus der Bindungstheorie, belegen einen Zusammenhang zwischen früher Bindungsunsicherheit oder Störungen in der Eltern-Kind-Interaktion und späteren Verhaltensproblemen beim Kind. Dabei gilt frühe (hoch-) unsichere Bindung dann als Risikofaktor, wenn sie in Kumulation und in Wechselwirkung mit anderen psychosozialen Risiken auftritt. Diese Befunde, ebenso wie jüngere Forschungsergebnisse über die Bedeutung sensibler Perioden in der Gehirnentwicklung, sprechen für die Notwendigkeit beziehungsorientierter und früher Intervention, besonders in Familien mit psychosozialen Risiken. Dabei wird frühe und präventive Intervention in Anlehnung an Stern als ein klinisches Feld mit qualitativ neuen Anforderungen diskutiert. Diese lassen sich aus den Besonderheiten der Entwicklungspsycho(patho)logie der frühen Kindheit ableiten. Es werden beispielhaft Interventionsansätze vorgestellt, die den Prinzipien von theoretischer Konzeptualisierung und Wirksamkeitsüberprüfung entsprechen, wie sie in Leitlinien für präventive Intervention gefordert werden. Aspekte der nachhaltigen Einbindung präventiver Interventionsansätze in bestehende Hilfesysteme werden abschließend diskutiert.     

Kriminogene Entwicklungsrisiken von Jugendlichen mit Zuwanderungsgeschichte und M?glichkeiten der Pr?vention und Intervention

The higher rates of violence in the group of juveniles with a migrational background play a prominent role for criminology as well as for pedagogical and social practice in Germany. The following article gives an insight into some environmental and personal risk factors of this group, which could be responsible for their higher susceptibility to violence and delinquency. In the next step some conceptual questions of prevention and intervention are identified and illustrated with existing practical examples. Finally, the author makes some suggestions for further ways of violence prevention and analyzes the efficacy and ways of optimizing the existing programs for young migrants and their families.     

Prävention chronischer Krankheiten und Gesundheitsförderung

Zusammenfassung In den vergangenen 50 Jahren konnten große Fortschritte in der Entwicklung und der Umsetzung des verhaltensmedizinischen Wissens über die Gesundheit von Individuen und Populationen erzielt werden. Allerdings kamen Gesundheitsförderung und Krankheitsprävention nicht allen Bevölkerungsschichten in und zwischen den einzelnen Ländern in gleichem Maße zugute. Die Ungleichheit der sozialen, psychischen und körperlichen Gesundheit zwischen den wohlhabendsten und ärmsten Bevölkerungsgruppen ist im Wesentlichen gleichgeblieben oder sogar gewachsen. Das Wissen darüber, wie solche Unterschiede in der Gesundheit entstehen, ist allerdings erst dann von Bedeutung, wenn es dazu verwendet wird, geeignete, langfristige und nachhaltige Präventionsstrategien auf mehreren Ebenen zu erarbeiten. Bei solchen Strategien spielen verschiedene Aspekte der globalen natürlichen ökologischen Umwelt und das Streben nach einer sog. gesundheitserhaltenden Umwelt eine wichtige Rolle. Mit dem wachsenden Einfluss der Globalisierung auf die Gesundheit stellt sich die Frage, welche Folgen jenseits der traditionellen nationalen Grenzen für die Krankheitsprävention und für die Gesundheitsförderung zu erwarten sind. Sie sollte uns anregen, darüber nachzudenken, dass die Verbreitung von wirksamen Interventionen auf institutioneller oder politischer Ebene nicht nur innerhalb eines Landes, sondern auch zwischen verschiedenen Ländern von höchster Wichtigkeit ist. In Anbetracht der global und schnell voranschreitenden ökonomischen und sozialen Veränderungen und des gewaltigen Einflusses von globalen Umweltveränderungen auf die Gesundheit müssen die Bandbreite und die Praxis der Verhaltensmedizin erweitert werden.Aus dem Englischen übersetzt von Dipl.-Psych. Erika Nemény, Berlin und Prof. Dr. Ulrike Ehlert, Zürich     

Entwicklungsbezogene Pr?vention von Gewalt und Kriminalit?t

This article provides an overview of concepts and empirical evaluations of developmental prevention of delinquency, violence and other forms of antisocial behavior in childhood and youth. At first basic terms and arguments are discussed; then a selection of family, child school and community-oriented programs are briefly presented. There follows an integrative evaluation of the field that is mainly based on systematic reviews and meta-analyses. An integrative model shows that preventive effects depend on many characteristics of the programs, contexts, participants and evaluation methods. In total effect sizes are positive and small but show practical relevance. There is a strong need for more well controlled outcome evaluations with long-term follow-up and more process evaluations of implementation and quality assurance. Future research and practice should be integrated within a long-term and cross-departmental prevention policy.     

Gewaltprävention statt Präventivschlag

Die Psychotherapie -     

Zur Problematik der Suchtgefährdung von berufstätigen Medizinern

Two samples of working physicians have been compared in a cross-sectional study – one representative sample of addicted physicians with a substance abuse problem (n=142) and one representative sample (n=275) of physicians in general; the objective was to develop preventive strategies. As a measuring instrument a specific questionnaire on quality of life of physicians (Reimer and Jurkat) has been used. Generally, quality of life is lower in the substance abuse sample in comparison to the control group. It can be concluded that the variables concerning the areas life satisfaction/-dissatisfaction and health differentiate even more between the groups than the areas work satisfaction/-dissatisfaction and choice of occupation. Whereas quality of life of female physicians was on the average somewhat higher than that of their male colleagues in the control group, this could not be confirmed in the sample of impaired physicians. Especially the ability to relax seems to be essential as a preventive measure, and apparently it is of high importance for working physicians to care for an adequate and satisfying private life to balance their stressful working life.     

Zur Häufigkeit der Schuldfähigkeitsbegutachtung von Sexualstraftätern im Erkenntnisverfahren

This study investigated how often and depending on which factors sexual offenders are examined by mental health experts regarding their criminal responsibility. Out of a total of 306 legal charges against sex offenders accused of child sexual abuse (CSA: n?=?145), rape or sexual assault (n?=?89), exhibitionism (n?=?39), sexual abuse of adolescents, mentally defective, physically helpless or warded persons (n?=?18) that were admitted by a criminal court in 2001 in the German federal state of Schleswig-Holstein, 209 (95.6 %) were analyzed regarding the following questions: how often was the accused examined by a mental health professional regarding mental responsibility? Was the chance of being examined systematically related to certain factors (e.g., personality of the accused)? Expert advice regarding the mental responsibility of the accused was obtained by the court in only 34 cases (11.7 %). No systematic relationships of personal variables as well as the modus operandi and the chance of commissioning a mental health expert were found. The main reason for assigning a forensic expert opinion was the vague impression of a psychic disorder. Re-offending increased the rate of a mental health examination only in CSA (34.6 % of re-offenders were examined compared to 9.2 % of first-time offenders), but not in rape or sexual assault. Also age does not predict the commissioning of an expert opinion. Only one fifth of all accused below the age of 21 were investigated by a mental health professional. Results are discussed in terms of legal background, consequences for risk assessment and relapse prevention.     

Diagnostische Methoden in der Gesprächspsychotherapie

As in other scientifically recognized psychotherapy procedures diagnostic methods are highly valued in modern client-centered psychotherapy. On the one hand diagnostics provide the necessary documentation of the effects of therapy (as legally prescribed), on the other hand they enable the indications for psychotherapy and monitoring of the therapy process. Besides theory-overlapping instruments (especially for comparing the effects with those of other therapies) there is a respectable repertoire of client-centered theory-oriented diagnostic methods, primarily for the diagnostics of essential process variables. For the three domains of diagnosis, pretesting, process diagnosis and post-testing, the methods used by client-centered therapists are introduced and theory-oriented methods are delineated with recommendations for acquisition. Moreover, the use of other procedures is also suggested.     

Homosexualität und Prägung

Ohne ZusammenfassungMit Unterstützung der Deutschen Forschungsgemeinschaft.     

Zur Interpretation der strukturalistischen Auffassung über die Prüfbarkeit von Theorien

Struve has tried to refute my critic of the structuralist thesis that testing theories leads in an epistemological circle. But he misunderstands the thesis he wants to defend.     

Zur Geschichte und gegenwärtigen Lage der Philosophie in der ČSR

Official Czech philosophy has been dominated by a mix of Engelsian philosophy of science and positivism, a combination explained in part by the survival of positivism in Czechoslovakia and the failure of analytic philosophy to make inroads into Czech thinking. However, due to Jan Patoka's influence in espousing the works of Husserl and Heidegger, there was an anthropologically oriented Marxism (K. Kosik) although its successes were greater abroad than in Czechoslovakia. A more neopositivistic variant (L. Tondl) of Marxism also appeared, but it was a short-lived phenomenon without purchase on mainstream philosophy.A certain renewal of Czech philosophy was evident before 1968, once again largely due to Patoka's influence. Foreign guests who took part in informally organized, often secret, seminars and discussion groups were very instrumental in spreading new ideas. Despite these positive occurrences, Czech philosophy is experiencing a crisis at the level of the middle generation of non-academic, philosophically competent intellectuals among whom sceptical and nihilist attitudes prevail. A rebirth of spirit may be in the offing if the recovery of the specific sense of the Czech Reformation's idea of truth is pursued.     

Prävention seelischer Störungen bei Kindern

During the last years psychosocial prevention became more and more established. The need for a focus on “early intervention” is a consequence of scientific research on the effects of psychosocial stress in infant development. Mental and neural development in the infant years is very modifiable, thus primary prevention has to centre on advancements in the immediate conditions of maturation. This is exceedingly important for children in families at risk. This article gives an overview of actual preventive measures, especially of those in the German-speaking countries.     

Anfänge und Entwicklung der Leistungsmotivation: (II.) in der Zielsetzung des Kleinkindes

Ohne ZusammenfassungDiese Arbeit ist Herrn Prof. Dr. Wolfgang Metzger zum 65. Geburtstag gewidmet.