Somatische und psychische Komorbidität

Studies indicate that chronic somatic diseases are often associated with psychological burden and manifest mental disorders. The interaction may be a complex one rather than a mere reaction to severe somatic illness. Early recognition of psychosomatic comorbidities has important implications for adequate diagnostic classification, therapy, and the course of the whole disease pattern. The timely treatment of depression in somatic illnesses can for example not only alleviate depressive symptoms but also raise quality of life and reduce the consequences concerning the course of the somatic disease. However, many questions still need to be answered relating to the concrete influence of a therapy of the mental disorder on the somatic prognosis.     

Abuse Experiences in a Community Sample of Young Adults: Relations with Psychiatric Disorders, Sexual Risk Behaviors, and Sexually Transmitted Diseases

This study documents significant associations among lifetime abuse experiences, psychiatric diagnoses, and sexual risk behaviors in a multiethnic community sample of young men and women (N = 1803) in South Florida. Self-report data were collected via structured interviews as part of a longitudinal follow-up of a larger school-based study. Participants were grouped according to extent of lifetime abuse experiences. Cumulative lifetime abuse experiences were associated with increased risk for a broad range of individual lifetime psychiatric disorders, as well as cumulative lifetime psychiatric disorders. Both cumulative abuse experiences and cumulative psychiatric disorders were independently associated with (a) higher levels of sexual risk behaviors and (b) higher risk for lifetime sexually transmitted diseases (STDs). Implications for selective prevention of sexual risk behaviors and STDs among young adults with histories of abuse and psychiatric disorders are discussed.     

Dissoziative Störungen des Bewusstseins

Dissociative disorders often develop after chronic traumatization. But they can also occur without preceding traumatization. Newer psychodynamic concepts explain dissociation as a specific defense-constellation and as a result of specific neurobiological and neuroanatomical effects of trauma. In dissociative disorders differentiated interdisciplinary somatic and psychiatric diagnostic procedures should be performed. Many somatic and psychiatric disorders should be considered concerning the differential diagnosis. Specific therapeutic techniques have to be applied.     

Idiopathic physical symptoms: a common manifestation of psychiatric disorders in primary care

Worldwide, patients with common mental disorders, such as depression and anxiety, have a tendency to present first to primary care exhibiting idiopathic physical symptoms. Typically, these symptoms consist of pain and other physical complaints that remain medically unexplained. While in the past, traditional psychopathology emphasized the relevance of somatic presentations for disorders, such as depression, in the last few decades, the "somatic component" has been neglected in the assessment and treatment of psychiatric patients. Medical specialties have come up with a variety of "fashionable" labels to characterize these patients and the new psychiatric nomenclatures, such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, attempt to classify these patients into a separate "somatoform disorders" category. These efforts fall short, and revisionists are asking altogether for the elimination of "somatoform disorders" from future nomenclatures. This review emphasizes the importance of idiopathic physical symptoms to the clinical phenomenology of many psychiatric disorders, offers suggestions to the diagnostic conundrum, and provides some hints for the proper assessment and management of patients with these common syndromes.     

Electrical stimulation of the brain for psychiatric disorders

Despite advances in therapies, there remain psychiatric patients who are extremely ill and cannot be helped by classic psychiatric treatments, including psychotherapy and drug therapy. Certain of these patients may be helped by use of bilateral brain lesioning. The complication rate of standard stereotactic psychosurgery techniques is very low. The main rationale for the continued experimental use of deep brain stimulation (DBS) in neurosurgery for mental disorders is its reversibility. This reversibility is not an advantage in terms of the benefits obtained, but rather if side effects emerge. In addition, electrical stimulation may provide patients with some autonomy for their treatment. The first, very preliminary results of electrical stimulation for obsessive-compulsive disorder and for a small heterogeneous group of patients with other psychiatric disorders have been published. Electrical stimulation of the brain for psychiatric disorders may become a new treatment option for certain intractable psychiatric disorders. Nevertheless, the mechanism of action of DBS in psychiatric disorders is unknown, and the experience with this modality is extremely limited. The first results look promising, but this treatment option may prove unusable for some time because of a lack of knowledge of appropriate brain stimulation targets and technical problems such as the availability of sufficient current supply.     

Surgery for psychiatric disorders

The modern therapeutic approach to most psychiatric diseases involves a combination of well-supervised psychotherapy, pharmacotherapy, and electroconvulsive therapy. Patients who fail to adequately respond to these modern treatment methods and remain severely disabled may be considered for surgical intervention. Cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy are the most common psychosurgical procedures performed today, with response rates in the 35% to 65% range. Modern stereotactic techniques have reduced complication rates, but controversy remains regarding the optimal surgical procedure. The major psychiatric diagnostic categories that might respond to surgery include treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states. Surgery should be considered as one part of an entire treatment plan and must be followed by an appropriate psychiatric rehabilitation program. It should only be carried out by an expert multidisciplinary team consisting of a neurologist a neurosurgeon, and a psychiatrist with experience in these disorders. Surgical intervention remains a reasonable therapeutic option for select patients with a disabling psychiatric disease and may be underutilized.     

Comparison of group climate in an eating disorders partial hospital group and a psychiatric partial hospital group

Women in an eating disorders partial hospital program and a psychiatric partial hospital program were compared on a self-report measure of group climate following a psychodynamic-interpersonal therapy group. Those with eating disorders experienced their groups as more engaged and as more avoiding than those in the psychiatric partial hospital group. Therapists may be able to use initial heightened engagement in eating disorder groups to counteract the tendency to avoid content.     

Dystonien

A fruitless debate as to whether dystonias are an organic or psychogenic condition has dominated the scientific approach to psychiatric issues in dystonias. E.g., spasmodic torticollis (ST) was once considered “neurotic”, whereas today rather the notion of reactive psychiatric disorders in ST prevails. In our review current clinical and etiological findings in this area are presented focussed on spasmodic torticollis in order to discuss the extent and quality of psychiatric comorbidity as well as the interaction between psychological and somatic factors. Finally, typical clinical cases are presented and discussed within a multidimensional psychotherapeutic and a psychoanalytically-oriented treatment approach.     

Phyloanalysis: Theoretical and Practical Considerations on Burrow's Group Analytic and Socio-Therapeutic Method by W. Riese and H. Syz

Abstract

Women in an eating disorders partial hospital program and a psychiatric partial hospital program were compared on a self-report measure of group climate following a psychodynamic-interpersonal therapy group. Those with eating disorders experienced their groups as more engaged and as more avoiding than those in the psychiatric partial hospital group. Therapists may be able to use initial heightened engagement in eating disorder groups to counteract the tendency to avoid content.     

Multimodal Exposure-Based Group Treatment for Peacekeepers With PTSD: A Preliminary Evaluation

Group therapy can effectively reduce posttraumatic stress symptoms. However, the available literature on multifaceted programs for military samples is limited and available studies typically do not evaluate outcomes on a broad range of related problems. This study describes a retrospective evaluation of a multimodal, exposure-based group treatment program for posttraumatic stress disorder (PTSD) and associated symptoms in 22 peacekeeping veterans who successfully completed treatment. Treatment consisted of exposure-based CBT, case management, psycho-education, creative arts therapy, psychomotor therapy, psychodrama, and socio-therapy, which were provided one day a week for approximately 21 months. Analysis of pre- and posttreatment assessments showed that coping styles and professional and personality functioning had improved and that anxiety, somatic, depressive, and PTSD symptoms were reduced after treatment. Because significant improvement was observed on several parameters, the program may have successfully addressed a broad range of problems frequently reported by veterans with complex and chronic PTSD.     

Structure of the Computer-Assisted Beck Anxiety Inventory With Psychiatric Inpatients

To determine the dimensions of self-reported anxiety in psychiatric inpatients, the Beck Anxiety Inventory (BAI; Beck & Steer, 1990) was administered by computer to 250 inpatients diagnosed with mixed disorders. An iterated principal-factor analysis was performed on the intercorrelations among the 21 BAI items using a Promax rotation. Two factors were found representing somatic and subjective symptoms of anxiety. These dimensions significantly matched those previously described by Beck, Epstein, Brown, and Steer (1988) for outpatients diagnosed with mixed psychiatric disorders. The generalizability of the somatic and subjective dimensions for inpatients and outpatients is discussed.     

Early interventions following psychological trauma

What is the best way to provide early interventions for psychiatric disorders after trauma? The terrorist attacks of September 11, 2001, have raised urgent concerns about the evidence for early treatments after trauma that can prevent psychiatric disorders. This review outlines the expected course of posttraumatic stress reactions and discusses the current means of identifying people who are at risk of developing disorders. A critique of psychological debriefing and an analysis of evidence for cognitive-behavioral therapy as an early intervention is provided. The major challenges for early intervention are discussed, including increasing treatment effectiveness, delivering therapy when it is required by thousands of people, and developing early interventions for a wide array of psychiatric disorders in addition to posttraumatic stress disorder that can develop following trauma.     

Psychotherapie chronischer Erschöpfungszustände

Chronic fatigue is common. Since fatigue has little specificity, it can be the consequence of many different somatic diseases and psychiatric disorders. Therapy needs to be individually tailored with regard to the underlying or assumed causes. When objective and established causes cannot be identified or cannot adequately explain the symptoms experienced, the diagnosis of chronic fatigue syndrome (CFS) is possible. But what is CFS? Is it a valid diagnosis? How can the chronic fatigue patient be treated? Based on an integrative understanding, a psychobiological etiological and psychotherapeutical model of chronic fatigue will be developed and described.     

Lamotrigine in psychiatry: pharmacology and therapeutics

Following the introduction of lamotrigine in 1994 as a treatment for epilepsy in the United States, the drug has seen progressively greater application in psychiatry, particularly as a treatment for bipolar disorder. This review critically evaluates the support for lamotrigine use across a broad range of psychiatric disorders as well as discuss its pharmacology, side-effect profile, and interactions with other medications.     

Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly

Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.     

Effekte regionaler Psychosomatiktherapiemodule

Psychosomatics from the perspective of medicine assumes that somatic, psychological, and social aspects must always be taken into consideration. By combining psychosomatic and psychiatric care in community psychiatric/psychosomatic networks, existing structures can be used and costs decreased due to synergies (best point of treatment). Using a 1?year pre-/postcatamnesis comparison of 106 patients, it was possible to determine the cost of the 3?week psychosomatic treatment with respect to the medical, sociotherapeutic, and psychotherapeutic treatment effects and how long it helped. Based on the results, inpatient intensive therapy of psychosomatic illnesses in regional psychiatric departments of general hospitals can be recommended as a future treatment option – taking into account that patient-related factors can predict treatment success.     

The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses

Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets.     

Cognitive-Behavioral Therapy for Insomnia in Older Adults

Sleep is disturbed by a range of factors across the lifespan. However, older adults experiencing disruptions in their sleep are often simultaneously contending with a range of comorbid medical and psychiatric conditions that compound the biological changes in sleep that commonly occur with age. Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard, nonpharmacological intervention for sleep disturbances, and is a cost-effective treatment approach that can occur in either individual or group format. It has also been shown effective in older adults with medical, psychiatric, and cognitive comorbid disorders. This review highlights the success of CBT-I with older adults, as well as studies that illustrate the use of alternative delivery methods and treatment modifications for complex clinical presentations.     

DSM-III and the revolution in the classification of mental illness

A revolution occurred within the psychiatric profession in the early 1980s that rapidly transformed the theory and practice of mental health in the United States. In a very short period of time, mental illnesses were transformed from broad, etiologically defined entities that were continuous with normality to symptom-based, categorical diseases. The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was responsible for this change. The paradigm shift in mental health diagnosis in the DSM-III was neither a product of growing scientific knowledge nor of increasing medicalization. Instead, its symptom-based diagnoses reflect a growing standardization of psychiatric diagnoses. This standardization was the product of many factors, including: (1) professional politics within the mental health community, (2) increased government involvement in mental health research and policymaking, (3) mounting pressure on psychiatrists from health insurers to demonstrate the effectiveness of their practices, and (4) the necessity of pharmaceutical companies to market their products to treat specific diseases. This article endeavors to explain the origins of DSM-III, the political struggles that generated it, and its long-term consequences for clinical diagnosis and treatment of mental disorders in the United States.