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.     

F?rderung der Gesundheit und der psychosozialen Selbstwirksamkeit bei Langzeitarbeitslosen

Background

The development of appropriate preventive measures aimed at the promotion of psychosocial capabilities and health behavior is based on the recognition that unemployment is associated with many physical, psychological and social problems.

Objective

A group program ??promotion of health and psychosocial self-efficacy in long-term unemployed?? was developed and investigated with respect to the effectiveness by a study group at the Clinic for Psychosomatic Medicine of the University of Rostock. The study was part of a project funded by the European Social Fund (ESF).

Methods

During the period from October 2009 to April 2010 the group program was implemented in 5 different groups and the sample included a total of 35 persons. To examine the effectiveness of the program the participants had to complete standardized questionnaires at the beginning and at the end of the program. Information as to what extent the unemployed suffer from mental stress was collected via the brief symptom inventory (BSI; Franke 2000). The questionnaire on resources and self-management skills (FERUS; Jack 2007) was applied to analyze the capabilities and the self-management skills of the participants.

Results

The unemployed subjects reported lower levels of aggressiveness and paranoid thinking (distrust) after their participation in the program. Regarding the self-management skills the participants improved their coping skills, self-instructions skills and also felt more hopeful with regard to their current environment and the future.

Conclusions

A systematic support of unemployed people regarding coping with the psychosocial problems associated with unemployment seemed to be important. The use of low structured group programs is a good possibility to implement them in different contexts with relatively few resources.     

Persönlichkeitsstörung und Intelligenzminderung

There have previously been only few objective investigations on the combined occurrence of intellectual disability and personality disorder. Despite this difficulty, from the current clinical viewpoint there is no doubt that at least people with mild intellectual disability can also develop personality disorders. In slight degrees of intellectual disability it is possible to psychopathologically describe the typical symptoms objectively. For the disorder symptomatic of combined personality disorder in people with an intellectual disability, there are no confirmed facts, publications or diagnostic rules. The diagnostic assignment of behavioral abnormalites as combined personality disorder with dependent and infantile components in people with intellectual diasabilities still does not seem to be justified. In people with medium to severe mental disorders only the comprehensive term “behavioral abnormalities” should be applied.     

Vitamin D und die diabetische Neuropathie: (k)ein Alleskönner?

psychopraxis. neuropraxis - Zahlreiche Studien zeigen eine Korrelation zwischen niedrigen Vitamin-D-Werten und diversen Krankheiten. Diese Assoziation konnte in einer großen epidemiologischen...     

Wie können Ressourcenbeschränkungen eines Dialogparters erkannt und berücksichtigt werden?

This paper reports on research on the question of how a dialog system can recognize and adapt to the resource limitations of its user: specifically, limitations of time and working memory. The results of an exploratory study, together with other empirical research, yield a number of probabilistic causal relationships among relevant variables. It is shown how these relationships can be represented in dynamic Bayesian networks and used as a basis for inferences and decisions of a dialog system.     

Psychotherapeutischer Prozess und Persönlichkeitsstörungen

This paper begins with a cursory overview of psychotherapy outcome research for personality disorders; however, relatively little is known about process research or process outcome relationships. It then focuses on relevant patient and therapist variables. Significant controversies in personality disorder treatment techniques are examined. Initially, studies generally associated transference interpretation with less favorable therapy outcomes. Recent work supports the possibility of differentiated correlations. There is increasing evidence that a moderate amount of transference interpretation and perhaps even a therapeutic alliance that is not so good, maybe indicative of an inner conflict with the therapist relationship, could ultimately be beneficial. This association most probably does not exist in cluster C personality disorders. A problem with this type of research is that clear definitions are often lacking. This complicates comparisons between studies and the influence of other mediating variables remains vague.     

Alkoholismus und Selbstzerstörung

First, the development of addiction theory in psychoanalysis is recapitulated on the basis of the works of W.D. Rost and A. Heigl-Evers. For the understanding of alcoholism two concepts are fundamental. The ego-psychological concept postulates addiction as an attempt of a weak ego to help itself, while the object-psychological concept of Rost considers some forms of alcoholism as an expression of unconscious self-destruction.The author of the present article examines on the basis of a case study of autodestructive alcoholism the strength and weak points of the approach of Rost and proposes certain expansions of the model regarding first the object relations of the addict and the counter-transference, where a strong entanglement of the therapist with the destructivity of the patient is obvious. In addition, further considerations about the role of the superego are necessary, which faces the ego with hostility. Finally, the nature of the primary object of the addict person and the nature of the substance as transferential object should be examined. In the case of these inner objects there is a strange mixture of positive and negative aspects having in their consequence a great destructive potential for the person. This constellation bears resemblance to the pathological personality organisation as understood in Kleinian literature.     

Arbeitsstörungen und Prokrastination

Work disruption and procrastination include dysfunctional behavior in the context of completion of tasks in occupational and personal fields as well as in school and professional training. A psychological model for the explanation of work disruption and procrastination is presented. Based on this model dysfunctional behavior occurs when individual skills and personality factors do not fit with the demands and conditions of the task. Especially when depression, some anxiety disorders, test anxiety as well as adjustment disorders and personality traits related to personality disorders are present, work disruption and procrastination can play an important role as additional problems. A modularized intervention program is presented which can serve as a support for self-help, counseling as well as professional psychotherapy. It includes the analysis of dysfunctional behavior and cognition, improvement of work-related techniques, time-management and work conditions and reduction of distraction from work as well as improvement of work-life balance.     

Wie können Langzeittherapien mit kürzeren Behandlungen verglichen werden?

Long-term psychotherapy is not recommended in the current guidelines, which are based on the criteria of evidence-based medicine, as there is a lack of confirmation for long-term psychotherapy by efficacy studies. Using the example of psychoanalytic long-term psychotherapy this article describes six dilemmas which impede the realization of efficacy studies for long-term psychotherapy. Finally, basic elements of a study design are proposed, which are considered as being adequate to compare (psychoanalytic) long-term psychotherapy with shorter treatment forms in terms of outcome and cost-effectiveness. The anxiety and personality disorders (APD) study is briefly described as an example of a study realizing the proposed design.     

Psychopathologie und Behandlung der Borderline-Persönlichkeitsstörung

Zusammenfassung Das Wissen über Psychopathologie, Ätiopathogenese und Behandlungsmöglichkeiten der Borderline-Persönlichkeitsstörung (BPS) hat sich in den letzten Jahren deutlich verbessert. Heute sehen die meisten Wissenschaftler eine generalisierte Störung der Affektregulation im Zentrum der BPS, deren Ursachen in Wechselwirkungen zwischen genetischen Faktoren, traumatischen biographischen Erfahrungen und dysfunktionalen Verhaltensmustern liegen. Störungsspezifische Therapieverfahren, insbesondere die Dialektisch Behaviorale Therapie (DBT) nach Linehan, flankiert von psychopharmakologischer Behandlung, zeigen gute Behandlungsergebnisse sowohl im stationären als auch im ambulanten Bereich. In jüngster Zeit wurden viel versprechende Konzepte zur Behandlung schwerer komorbider Störungen [Alkohol und Drogenabhängigkeit, Posttraumatische Belastungsstörung (PTBS)] entwickelt.     

Angststörungen und Phobien im Kindes- und Jugendalter

Anxiety disorders belong to the most frequent mental disorders in childhood and adolescence. They cause severe impairment, show poor long-term outcome and they are often not recognized as a mental disorder. For a reliable and valid diagnosis and treatment outcome evaluation a multi-informant approach is essential including information from the child and the parents. Methods of choice are structured clinical interviews and questionnaires filled out by the child and the parents. Meta-analyses showed that only cognitive-behavioral treatment can be considered as a sufficiently evidence-based treatment. No differences in outcome were found between individual and group treatments or child and family focused treatments. Medication treatment with selective serotonin reuptake inhibitor (SSRI) showed short-term efficacy. Major evidence-based interventions are psycho-education, exposure techniques and cognitive restructuring strategies.     

Guter Eindruck und Persönlichkeitsfragebogen

Ohne ZusammenfassungDie vorliegende Arbeit stellt einen Auszug aus einer Semesterarbeit über Probleme des guten Eindrucks dar, die auf Anregung von Prof. Dr. E. Rausch von H. Gregor im Sommer 1960 dunchgeführt wurde.     

Somatoforme Störungen und Bindungstheorie

Somatoform disorders are not only marked by somatic symptoms, but also by significant disturbances in interpersonal relationships. Interpersonal difficulties – including the maladaptive pattern of illness behavior and the resulting difficult doctor-patient-relationship – are an important field of therapeutic intervention (Nickel u. Egle 1999). The interpersonal problems which are characteristic in patients with somatoform disorders draw attention to the developmental aspects of these conditions. Attachment theory provides a promising framework for understanding these developmental features. In the paper presented we therefore apply concepts and observations from attachment theory to somatoform disorders. After a brief review of attachment theory we specifically discuss the developmental aspects of representation formation in somatization. As next, empirical evidence is reviewed that link attachment insecurity to the development of somatoform disorders. Finally a vulnerability model of somatoform disorders is outlined.     

Trauma und sexuelle Störungen

Background

Sexual disorders are common among patients with traumatic childhood experiences, especially when they were exposed to sexual abuse. Despite the fact that trauma-associated sexual disorders imply serious consequences for the persons concerned, to date the topic has not found much consideration in the research and clinical contexts.

Material and methods

This study investigated the prevalence and relationships of sexual disorders and experiences of sexual abuse in 189 patients (81?% women, 19?% men) with complex posttraumatic stress disorder. All participants completed the Interview zur Diagnostik der komplexen posttraumatischen Belastungsstörung (I-kPTBS, interview on diagnostics of complex posttraumatic stress disorder) and the traumatic antecedents questionnaire (TAQ).

Results

At least one sexual disorder was found in 77.2?% of the participants. In both sexes hyposexual disorders were more common than hypersexual disorders. Women showed more hyposexual disorders than men and men showed more hypersexual disorders than women. Of the participants 50.8?% reported experiences of sexual abuse and women were more often affected than men. The presence of hyposexual disorders was clearly associated with the existence of experiences of child sexual abuse.

Conclusion

There is a need for research on and effective treatment concepts for trauma-associated sexual disorders. The development of new therapeutic approaches should be realized in interdisciplinary cooperation.     

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