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.     

Beziehungsökologische Therapie bei Panikstörung

Background

In 2000/2001 the authors presented the theory and practice of the ecological approach to the psychotherapy of panic disorders. The aim of the present study was to investigate the psychotherapeutic effectiveness of its application, supplemented by cognitive behavioural elements. According to the ecological approach, panic disorder arises whenever external changes in the living conditions enforce changes in professional or interpersonal relationships, which had been previously postponed and/or avoided out of fear of their consequences.

Methods

A total of 24 therapies consisting of 11–20 sessions were examined. Patients were examined 5 times from the beginning of the therapy until at least 1 year after cessation. Standardized questionnaires for the diagnosis and severity of the panic syndrome were used including the Panic and Agoraphobia Scale (PAS), the Hamilton Anxiety Scale (HAMA), the Symptom Checklist (SCL) 90-R and a relationship questionnaire.

Results

In the subjects’ self-evaluation 67% had recovered or showed only mild symptoms 1 year after therapy compared to 75% in the evaluation by the therapists. Effect sizes before and after therapy varied between 0.78 and 2.73 and all were significant. In addition, we developed a questionnaire on relationships, according to the ecological hypothesis. This showed that more than 80% of the subjects experienced essential changes in their relationships prior to the onset of the panic disorder requiring further developmental changes, which could be mastered with increasing success in the course of therapy.

Conclusions

Compared to other studies the combination of ecological and cognitive-behavioural approaches in this study resulted in impressive symptom and therapy reduction in less than 20 sessions.     

Diagnose und Therapie der Zwangsstörung

Obsessive-compulsive disorder (OCD) is the fourth common psychiatric disorder with a life-time prevalence of 1–3% world wide. Symptoms of OCD are intrusive, repetitive thoughts (obsessions) with disturbing content. Often, repetitive acts (compulsions) are performed in order to defend oneself or others against suspected threats or evil. Genetic and neurobiological factors are assumed to generate a disorder-specific vulnerability. Cognitive-behavioural models however, may serve to clarify the pathological interplay between dysfunctional thoughts and learning processes. The article offers an actual view on symptoms, diagnostic criteria, aetiology and therapeutic principles, such that OCD no longer stays the “hidden disease” which causes high individual and socioeconomic burden.     

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.     

Stationäre körperbezogene Psychotherapie bei Anorexia und Bulimia nervosa

Disturbances of body-images in women with anorexia and bulimia nervosa are described at the behavioral, perceptional and affective-cognitive level. The disturbances of body image, which are often accompanied by personality-structural deficits and have a decisive influence on the course of disease, can be reached only in part by verbal forms of therapy. Considering these facts, we present an integrative clinical procedure in which the application of body-related therapy modules play a central role in supplement to cognitive-behavioral and psychodynamic forms of therapy. Process-oriented body-perception therapy in an individual setting and a communicative movement group therapy are used and their relevance to the in-patient therapy process examined from the patient’s point of view. The study reveals a high value of body-psychotherapy, wherebydifferences were observed between anorexia (15) and bulimia (27) patients in the course of the process. The results suggest an indication for the application of combined individual and group body-psychotherapy for hospitalized anorexia patients. A communicative body therapy in group form is also very important in the in-patient treatment of bulimia patients, but there is a differential indication with regard to individual body therapy.     

Psychodynamik und neurophysiologischer Befund bei einem Patienten mit einer zwanghaften Lesestörung

The present single case study is aimed to investigate neuro-physiological correlates of checking and ordering compulsions in a 40 years old patient suffering from obsessive-compulsive disorder (OCD) by means of the functional magnetic resonance imaging (fMRI) method. After the presentation of the psychogenesis and psychodynamic of the OCD case, the cardinal symptom, a compulsive reading disturbance, is described in detail. Based on the symptom analysis eight different texts, hierarchically arranged by their degrees of difficulty were composed and presented to the patient for reading during fMRI. The results of the fMRI during symptom provocation display significant increase of activation in fronto-thalamic-cortical neural circuits with the occurence of compulsive reading disturbances compared with unproblematic texts and with the reading of a control subject. The findings are discussed in relation to the neurobiologic literature as well as to an object-psychological model of the OCD.     

Patientin mit komplexer somatoformer Schmerzstörung

Ohne Zusammenfassung     

Tötung mit und ohne tiefgreifende Bewusstseinsstörung

The category of “serious disturbance of consciousness” within the regulations for criminal responsibility has caused some uncertainty since is implementation in German Penal Law in 1975. It is applicable for those cases of “crimes of passion” where the mental functioning is heavily disturbed by massive affective arousal. A proposal for assessment and evaluation of such cases with a psychopathological approach is presented. The forensic-psychiatric examination contains 3 elements: (1) the formulation of the case in terms of biography, personality and special situation in the time before the criminal act, (2) a systematic analysis of the act according to two sets of specific criteria for such cases, (3) an evaluation of the state of consciousness by means of a “psychopathological reference system”, comparing all states of normal, abnormal and pathologically disturbed consciousness     

Die stationäre Behandlung von Zwangsstörungen mit multimodaler Verhaltenstherapie

The results of a 1-year-follow-up study concerning the treatment of 30 in-patients suffering from obsessive-compulsive disorder (OCD) are presented. This prospective study was carried out at the Psychosomatic Hospital Windach. Beside a multimodal setting the central treatment component was flooding and response prevention. Group analysis showed significant improvements in all measures (BDI, STAI-X1, Y-BOCS and self-ratings). The results of the follow-up indicate, that more than 70% of the patients maintained their positive treatment response over 1 year (symptom improvement >30%). The average reduction of symptoms was 42%. Average treatment duration was 12 weeks. A high initial depression score (BDI >18) predicted a worse outcome.     

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.