Primärprävention bei Essstörungen

Zusammenfassung Essstörungen gelten als schwer therapierbar. Mit einer Mortalitätsrate von 5–16% ist Magersucht die schwerste psychosomatische Erkrankung bei Mädchen und jungen Frauen. In den letzten Jahren wurde daher verstärkt versucht, der Entstehung von Essstörungen durch präventive Maßnahmen entgegenzuwirken. Der Schwerpunkt liegt hierbei auf der Primärprävention im Rahmen von Schulprojekten. Hierfür liegen bereits ermutigende Wirkungs- und Qualitätsnachweise vor. Entsprechende Projekte stehen im Zentrum der vorliegenden Übersichtsarbeit. Diese stellt keinen Anspruch auf vollständige Darstellung, sondern ist ein Versuch der Systematisierung unterschiedlicher Herangehensweisen und soll durch die kurze Beschreibung möglichst prototypischer und evaluierter Beispiele einen Einblick in die derzeitige Praxis der Primärprävention von Essstörungen geben. Quellen der Übersicht sind die Datenbank der Bundeszentrale für gesundheitliche Aufklärung (BZgA), Veröffentlichungen in Fachzeitschriften sowie Internetauftritte. Da Art, Umfang und Umsetzung der Präventionsprogramme sehr von politischen Bedingungen und Voraussetzungen innerhalb des Gesundheits- und Bildungssystems abhängen, bleibt die Übersicht auf Programme aus dem deutschen Sprachraum beschränkt.     

Videotherapie bei postpartalen Störungen

Video recording is currently part of in- and out-patient therapy programs for parents with infants. The observation and analysis of video sequences allow the patient to gain an extraordinary insight with respect to its own experience and behaviour. Video Microanalytical Therapy (VMT) looks for the mother’s positive qualities in her relationship to the child and employs these qualities in order to support successful interactions. VMT is well-suited to the treatment of mothers with postpartal affective or psychotic disorders, because the typical cognitive distortions and reduced perception shown by these mothers can be avoided to a large extent through the use of pictures. In this study, a video microanalytical therapy concept will be presented, that was developed for the treatment of postpartally disordered mothers at the Psychiatric Centre Nordbaden in Wiesloch, Germany.     

Verhaltenstherapie bei dissoziativen Störungen

Zusammenfassung Epidemiologische Daten bezüglich dissoziativer Auffälligkeiten werden vorgestellt. Diagnostizierbare dissoziative Störungen werden im Bereich des pathologischen Pols eines Kontinuums dissoziativer Phänomene eingeordnet. Ausgehend von der allen dissoziativen Störungen gemeinsamen Kernsymptomatik der strukturierten Separation mentaler Prozesse aus der ganzheitlichen Wahrnehmung wird ein universelles Ätiologiemodell dieser Erkrankungen dargestellt. Es basiert im Wesentlichen auf neueren Erkenntnissen der Neurobiologie und Gedächtnisforschung und bezieht sich auf die Traumatisierung als zentralem pathologenetischem Agens. Hiervon ausgehend, wird ein 2-phasiges Therapiemodell vorgestellt. Als Ziel wird ein Aussetzen bzw. eine Reduktion der dissoziativen Symptome über eine Integration der traumatischen Erfahrungen angestrebt. Die beschriebenen therapeutischen Vorgehensweisen sind grundsätzlich bei allen traumatisch bedingten dissoziativen Störungen anwendbar. Auf Konversionssymptome sowie die dissoziative Identitätsstörung wird als Sonderfälle separat eingegangen.Der Text basiert auf dem gleichnamigen Vortrag, den die Autorin am 24.10.2003 auf dem 5. Wissenschaftlichen Kongress der Deutschen Ärztlichen Gesellschaft für Verhaltenstherapie in Bad Pyrmont gehalten hat.     

Einschränkungen der Willensfreiheit bei somatoformen Störungen

Etiopathogenetic models of somatoform disorders and philosophical concepts of free will refer to theories of affect processing: affective dysregulation can promote psychosomatic ailments as well as problems in decision making. This observation brings forth the question if freedom of will is impaired in persons with somatoform disorders. By compiling, analyzing and contextualizing relevant models of current neuroscience, psychosomatic medicine and philosophy the psychodynamic construct of alexithymia as an etiologic factor of somatoform disorders and the conceptual integration of affective factors in a model of free will are developed on the basis of a common concept of affect. The synthesis of the discussed results and considerations, the multidimensional impairment of the ability to decide freely and self-determinedly due to somatoform disorders, is critically reflected; however, a blanket assumption is not admissible.     

Die Beurteilung der Steuerungsfähigkeit bei psychischen Störungen

Psychiatric assessment of culpability is conducted in two steps: firstly, the psychiatric diagnosis is to be made and attributed to one of the legal terms that entail the requirements for diminished or lack of legal responsibility. Secondly, one has to assess from a psychiatric perspective whether the mentally disturbed suspect who was aware of the unlawfulness of the actions was also able to act in accordance with awareness and to refrain from unlawful actions. The latter is called the capacity for self-control. The ultimately legal normative term of capacity for self-control corresponds to psychobiological concepts of executive and motivational self-control as well as to the psychological models of intentional control of actions (Goschke) and ”disactualization” (Janzarik). These concepts and models are outlined and discussed, particularly with regards to paraphilia and behavioral disorders. In the context of these conditions we sometimes find free-floating considerations about the capacity for self-control without even addressing the question whether the severity of the disorder has crossed the threshold for diminished legal responsibility. The author argues the case for an overall view of the suspect’s personality and abilities, weaknesses and decisions as displayed in the history of the criminal act.     

Traumafolgestörungen bei Erwachsenen, Kindern und Jugendlichen

Valid diagnostics are an essential foundation of a successful psychotherapeutic treatment. For posttraumatic stress disorders this is not always the case, i.e. when questionnaires are applied that do not completely comply with the criteria of a posttraumatic stress disorder according to the classification systems DSM-IV and ICD-10. In the present review, trauma questionnaires frequently applied in German-speaking areas for adults, children and adolescents are presented with their specificities and are critically discussed. Finally, recommendations for diagnosing posttraumatic stress disorders by means of questionnaires are made.     

Verhaltenstherapie bei Kindern und Jugendlichen mit Angststörungen

Research into anxiety disorders of children and adolescents have been neglected for a long time. Current work on the prevalence and on the course of anxiety disorders of children and adolescents impressively substantiates that (1) anxiety disturbances are the most frequent mental disorders of children and adolescents and, (2) represent important factors of risk for the development of anxiety disorders, depression and substance dependence/abuse in adulthood. The recent developments in behavior therapy on anxiety disorders with children and adolescents are presented first and the results of a meta-analysis of behavior therapy studies are summarized. The results of the meta-analysis show that anxiety disorders can be treated successfully in children and adolescents with behavior therapy. The follow up data show that therapy successes remain stable over a timespan of several years. In comparison of individual and group therapy as well as child and family-based therapy, there are no important differences with regard to therapy success.     

Prävention

Ohne Zusammenfassung     

Psychische Störungen bei HIV-Infektion und Aids

The human immunodeficiency virus (HIV) is the pathogen responsible for acquired immune deficiency syndrome (AIDS). Worldwide there are currently about 40 million people infected with HIV and an estimated 44,000 in Germany. If left untreated after a few years the infection leads to the manifestation of AIDS and eventually to death through opportunistic infections and malignant tumors. Infection with HIV is not curable. Nevertheless, antiretroviral treatment can slow the progress of the disease and prolong life expectancy significantly. Once antiretroviral treatment has started the medication must be taken regularly and lifelong. Serious side effects of the medication pose a significant stress on physical and psychological well-being and impair adherence. Infection with HIV means a total change in life perspectives and requires extensive adaptations in lifestyle. Problems with adaptation and mental disorders (e.g. depression, anxiety disorders, adjustment disorder) are, therefore, frequent. With disease progression neurocognitive impairments are increasingly likely. Mental disorders and neurocognitive impairments adversely affect treatment adherence, increase health risk behavior and reduce immune function. Psychological interventions contribute significantly to the reduction in health risk behavior, improve treatment adherence and are successful in the treatment of depression and anxiety.     

Systemische Therapie bei Störungen des Erwachsenenalters

Background

Systemic therapy is a scientifically acknowledged form of psychotherapy in the US and many European countries, but not yet in Germany.

Method

All randomized (or parallelized) controlled trials (RCT) evaluating systemic couples/family/individual therapy with adult index patients published in English, German or Spanish up to the end of 2004 were identified via data base searches and cross-references in other meta-analyses and reviews. A meta-analysis of the identified RCT was performed.

Results

28 RCT (43 publications) evaluating systemic therapy with adult index patients suffering from clinical disorders (ICD-10) were identified. Systemic therapy is efficacious with regard to substance disorders, mental/social factors interacting with somatic disorders, schizophrenia, depression and eating disorders. The results are stable across follow-up periods of up to 5 years.

Conclusion

According to the criteria of the German Scientific Advisory Board Psychotherapy (Wissenschaftlicher Beirat Psychotherapie) there seems to be good evidence for the efficacy of systemic therapy in at least four fields of application of adult psychotherapy.     

Somatoforme Störungen bei ambulanten dermatologischen Patienten

Zusammenfassung In der vorliegenden Studie wurde die Häufigkeit somatoformer Symptome in einer dermatologischen Universitätsambulanz untersucht. An der Studie nahmen n=195 Patienten teil, die Screeningfragen zu somatoformen, dermatologischen und depressiven Symptomen ausfüllten. Zusätzlich wurde eine dermatologische Beurteilung der Symptome hinsichtlich der Ätiologie erfasst. Danach wiesen 26,2% der Patienten Hinweise auf eine somatoforme Störung auf; am häufigsten waren somatoforme Schmerzstörung (16,9%) und körperdysmorphe Störung (15,4%). Unter den spezifischen dermatologischen Symptomen wurde Juckreiz besonders häufig (10,3%) als somatoform klassifiziert. Der Anteil von Patienten mit erhöhten depressiven Beschwerden lag bei 17,3%. Die Ergebnisse sprechen für eine erhöhte Prävalenz somatoformer Störungen bei dermatologischen Patienten. Die Identifizierung und psychotherapeutische Versorgung dieser Patientengruppe sollte in der dermatologischen Routineversorgung mehr Beachtung finden.     

Affektverarbeitung und Beziehungsgestaltung bei somatoformen Störungen

Somatoform disorders are usually associated with disturbances in affective processing and consequently with relational disorders. The effect of psychotherapy on the emotional regulation and the relational behaviour in the course of treatment of a patient with somatoform autonomous dysfunction and dysthymia has been examined. Pre-post comparisons of inpatient treatment have been performed by means of standardized questionnaire data; the course of therapy has been evaluated by the analysis of the dependence of the leading symptom of hypogastric pain on mood parameters with the help of multivariate time-series analyses. One effect of psychotherapy was the initiation of an intrapsychic discourse, which led to an improved ability of affect regulation as well as to a better functioning in relationships. This was accompanied by a reduction of somatization. The interrelations between somatization, affect- and relationship-regulation are discussed.     

Zahnhartsubstanzschäden bei Essstörungen

Eating disorders such as anorexia nervosa and bulimia nervosa lead to several serious physical problems. One possible consequence is acid-related dental erosion. Dental erosion can be identified early and is caused by exogenic (selection of food) and / or endogenic (gastric acid) factors. That is why dentists play an important role in the early identification of eating disorders as well as in the prevention and therapy of dental erosion. They should be important collaborators of psychotherapists. We review characteristic damages to the teeth that are seen in eating disorders as well as preventive and therapeutic interventions. Psychotherapists should be informed about dental problems and preventive strategies to educate their patients.     

Interkulturelle Aspekte bei der Behandlung somatoformer Störungen

Patients from family-oriented societies have a different perception of pain and different conceptions of healing, which up to now have not been sufficiently appreciated in modern multimodal therapeutic approaches. Inadequate knowledge of anatomy and bodily functions and traditional perceptions of pain (e.g. magic, curses, punishment, etc.) have a substantial influence on diagnostics. The pain experience is regarded holistically in relation to the body, rather than being confined to a particular part of the body. Limited access to psychological complaints often leads to physical complaints. The ailing body is an expression of the social, the economic, the psychological and cultural state of the patient and the history of migration and status in the collective. A multimodal interdisciplinary and culture-sensitive approach is required for effective pain treatment of patients with a tradition-bound background.     

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.