Nachsorge nach station?rer Psychotherapie f��r Essst?rungen

Background

Despite high relapse rates there is a lack of feasible, effective and efficient interventions to provide aftercare support to patients who complete treatment for an eating disorder. A program based on the short message service (SMS) and text messaging has been developed in order to provide such additional support to patients who undergo inpatient treatment for an eating disorder.

Materials and methods

A total of 165 patients with bulimia nervosa or an eating disorder not otherwise specified were randomly assigned either to the intervention group (n?=?82) with access to the text messaging intervention for 4 months following discharge from hospital or to the control group (n?=?83). The efficacy of the intervention was determined via the three eating disorder related subscales of the Eating Disorder Inventory (EDI-2) at 4 and 8 months follow-up and via the frequency of self-reported binge eating and compensatory behaviors (vomiting and abuse of laxatives) in the Short Evaluation of Eating Disorders (SEED) at 8 months follow-up.

Results

Participants in the intervention group reported significantly lower impairment on the EDI scales drive for thinness and body dissatisfaction both at 4 and 8 months follow-up. They also reported significantly fewer episodes of binge eating and vomiting. No differences were found for the EDI subscale bulimia and for the frequency of the use of laxatives.

Conclusion

The intervention based on text messaging proved efficacious in the aftercare treatment of patients with eating disorders. Chances and limitations concerning its use in the clinical routine as part of a stepped care model are discussed.     

?Psychische St?rung�� als Begr��ndung f��r staatliche Eingriffe in Grundrechte des Individuums

When dealing with ?old cases?? of preventive detention as well as retrospectively ordered preventive detention, a continuation of confinement should be possible if the offender involved suffers from a ??mental disorder?? which constitutes the danger of future serious violent or sexual crimes. In this psychiatric article it will be explained that the terms ??mental illness?? and also ??mental disorder?? must retain an empirical scientifically definable psychiatric content in order not to instigate deception. They must also be functionally defined in each judicial environment (police law, social law, civil law and criminal law) with respect to the capabilities of the individual which are impaired by the mental disorder. Such an approach could prevent a misuse of psychiatry for purely political security purposes.     

Kognitive St?rungen als führendes Symptom einer Multiplen Sklerose

Die multiple Sklerose (MS) ist eine chronisch entzündliche zumeist schubhaft, seltener auch prim?r progredient verlaufende Erkrankung des Gehirns und des Rückenmarks auf vermutlich autoimmuner Genese. Sie beginnt meist im jungen Erwachsenenalter und verl?uft über viele Jahrzehnte. Pr?sentierende Symptome und Symptome der ersten Erkrankungsjahre sind meist Sehnerventzündungen, motorische St?rungen, Gleichgewichtsprobleme und sensible Ausf?lle. Gelegentlich kann es in den frühen Phasen der Erkrankung auch zu Blasenst?rungen kommen. Auch subtile kognitive Beeintr?chtigungen und Fatigue k?nnen nicht selten bereits nach relativ kurzer Erkrankungsdauer nachgewiesen werden. Zu im Alltag beeintr?chtigenden kognitiven St?rungen kommt es allerdings typischerweise erst nach langem Krankheitsverlauf. Ein ausgepr?gtes Demenzsyndrom ist bei Multipler Sklerose allerdings untypisch und wenn es bereits früh und ohne sonstige wesentliche neurologische Ausf?lle auftritt, extrem ungew?hnlich. Allerdings sind in der Literatur einzelne F?lle mit zumeist prim?r progredienten Verl?ufen beschrieben, deren führendes Symptom bereits früh in der Erkrankung eine Demenz war. Im folgenden soll ein Fall mit Demenz ohne sonstige wesentliche neurologische Ausf?lle vorgestellt werden.     

Psychodynamik und Psychotherapie psychotischer St?rungen

This article gives a review of the options for psychodynamic treatment of patients with psychoses. The various settings for individual treatment as well as group and family therapy will be presented with a special emphasis on modified analytical long-term therapy. For a psychodynamic understanding, which is the basis for this treatment, the most important psychoanalytical models for psychotic disorders will be presented. In addition the current empirical results of non-explicit psychodynamic-oriented research will be referred to, which emphasize the significance of traumatic events in the early phases of life and the importance of narrative elements, whereby the psychodynamic approach experiences both complementation and confirmation.     

Psychoedukation bei Borderline-Pers?nlichkeitsst?rungen für Betroffene und Angeh?rige

Psychoeducation programs have been developed for patients with psychoses and also for patients with borderline personality disorder (BPD). Psychoeducation has the function of a basic psychotherapeutic program that offers patients and their relatives a better understanding of the illness and of the treatment options as well as a means of communication at eye level with the therapists. This article introduces the Munich model of psychoeducation for BPD and the modifications for the work with relatives.     

Eckpunkte f��r den Vollzug der Sicherungsverwahrung

A working group from the states of Berlin and Brandenburg has worked out benchmarks for the structural organization of detention and reprimand for people who have been sentenced to preventive detention in addition to the actual punishment. Decisive for this from the very beginning was the idea to maintain the aim of social reintegration of convicted persons and to adapt the execution of preventive detention not only formally to the guidelines of the European Court of Human Rights.     

Seelische Gesundheitsvorsorge f��r Kinder krebskranker Eltern

Children of cancer patients are increasingly being paid attention to as target group for family-based mental health prevention concepts in psychosocial oncology. Based on the long-term experiences with the concept Children of Somatically Ill Parents (COSIP) for child-centred medical family counselling, which was developed at the counselling service COSIP at the Hamburg University Medical Centre, a specialized manual was developed for the context of psychosocial care in oncology, which is currently being tested in a multi-center approach. In this article the theoretical framework and the practical steps of this manualized concept in caring for families with a parent having cancer are summarized. Characteristic elements are the flexible handling of the three system levels parents, family and child in the counselling setting as well as focussing on previously defined intervention goals which are expected to strengthen the coping resources in the family and the children. Perspectives for clinical practice and research are discussed.     

Psychoanalytische Kurzzeittherapie f��r Kinder von 4 bis 10?Jahren

Depressive disorders in childhood are not easily identifiable as distinct nosologic entities because of high comorbidity and developmental specificities of their appearance. Psychopathologic developments show that early recognition and prevention of depressive disturbances have a high relevance in health care. In the following article the authors present the basic principles of the psychoanalytic short-term therapy (PaKT) for the treatment of affective disturbances and emotional symptoms in childhood which they worked out as therapy guidelines in form of a manual.     

Einzel- und Paarintervention f��r depressive Koronarpatienten

Depressive symptoms in patients presenting with coronary heart disease have an impact on quality of life, health behavior, and prognosis. The psychotherapeutic interventions which had been tested for their efficacy in previous randomized controlled trials, showed only minor effects. A stepwise approach consisting of individual and group psychotherapeutic interventions was tested for efficacy in a German multicenter study. The presented paper describes the therapeutic procedure for two individual sessions and one couple session by means of case examples. The main focus was to determine depressive symptoms along with underlying maladaptive personality traits such as negative affectivity and social inhibition (type D pattern). Depressive mood, disappointments and mortifications both in private and professional life and also during the previous treatment are verbalized. Dysfunctional relation patterns and maladaptive sickness behavior are taken up by the psychotherapist and alternative behavior patterns are developed. The objective of the couple session is strengthening the partnership resources and offering relief of fears and worries relative to the heart disease. The psychotherapeutic procedure is psychodynamically oriented but also contains cognitive-behavioral and interactional treatment approaches.     

Somatoforme Störungen

The therapy of somatoform disorders should focus on the reduction of physical symptoms. A constant improvement of these symptoms is not possible without the development of the body-self and the body-image, because serious somatoform disorders are always connected with problems of the self-structure, especially of the body-self and the body-image. A treatment approach is presented in a case study.     

Eine Schule für das Leben mit Schizophrenie

Schizophrenia usually appears in young people at an age when they are about to leave home, i.e. at a life stage which is already difficult without a psychological disorder. The “learning by doing” program of “Pension Bettina”, which is described here, supports the affected persons and their families in the process of detachment from home and coping with the disorder. Special emphasis is laid on the difficult balance between increasing the autonomy of the affected person and providing adequate familial support.     

Die postpartale Bindungsstörung: Eine Risikokonstellation für den Infantizid ?

Background

The effectiveness of preventive approaches in the field of child protection depends, amongst other things, upon identifying typical risk constellations of infanticide. Postpartum bonding disorder, a disorder affecting a mother’s emotional relationship with her child, is one of those risk constellations alongside other negative consequences to child development. It frequently accompanies postpartum depression, which is determined by other emotional qualities. The therapeutic response is a determinant factor for the success of preventive measures.

Method

42 mothers with postpartum disorders (25 depressive, 17 schizophrenic) undergoing treatment at a mother-baby-unit were examined for bonding disorders and the therapeutic response, primarily regarding the mother-child relationship. Perception of bonding, maternal self-efficacy and objectively measured parameters of mother-child interaction were the most important parameters assessed. Results. Nearly 60% of the mothers suffered from a bonding disorder. Overall, the results indicated a clear improvement in psychiatric disorder as well as in the assessed parameters for the mother-child relationship and the experience of motherhood.

Conclusions.

Maternal bonding disorders are strongly associated with postpartum depression and low maternal self-efficacy, which can lead to a risk constellation for infanticide. The data confirm the therapeutic response, thus demonstrating that early diagnosis and treatment of postpartum depression can represent a timely and effective preventive approach in the field of child protection.     

Epidemiologie psychischer Störungen

The discipline of epidemiology not only contributes to knowledge regarding the distribution and prevalence of mental disorders but also to a better understanding of their causes and consequences. This article focuses on the prevalence and disease burden. Epidemiological studies show that mental disorders are more common than previously thought and that they are associated with a particularly high societal burden. Costs of illness are higher in mental disorders compared to many widespread somatic conditions because of their high prevalence, chronic course, young age of first onset and the profile of disability. The extent of inability to work due to mental disorders is rising steadily although a general decline in absenteeism has been observed across other disease types. This raises the question of whether mental disorders have increased recently. Furthermore, the general need for treatment is discussed as well as the corresponding mental health care options. Finally, it has been found that, despite the quantitatively relatively well-developed health care system in Germany, there are still signs of a significant undertreatment in the field of psychotherapy.     

Postpartale psychische Störungen

Any postpartum mental disorder in a mother can influence the mother-child relationship and communication and lead to the development of psychosomatic disorders or disorders of behavioral regulation with diagnostic status. These can have a long-term impact on the mother-child relationship and the child’s mental development. Based on research findings on mother-child interaction, the authors expound why including the child in treatment is crucial. Accordingly, possible contraindications for mother-infant treatment are described. Clinical parent-infant treatment practice is reviewed as an interdisciplinary and multiprofessional challenge and the necessity of adhering to minimum standards, beside adult psychiatric skills, of child psychiatric and developmental expertise in diagnostics and intervention for quality assurance.