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.     

Evidenzbasierte Diagnostik und Psychotherapie der Zwangsstörung

For a long time obsessive-compulsive disorder (OCD) was considered to be a mental disorder which is very difficult or practically impossible to treat. Based on comprehensive basic research on different models and derived treatment approaches empirical research has shown remarkable improvement in the psychotherapeutic treatment of OCD. Recently, S-3 treatment guidelines have been published on behalf of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften, AWMF). Based on these guidelines clinical diagnostic measures and state-of-the-art treatment recommendations are proposed. Specifically, the current article focuses on the step-by-step procedure in cognitive-behavioral intervention strategies and in particular on exposure and response prevention.     

Eine Schlafstörung kommt selten allein

Eine Schlafst?rung kommt selten allein: 67 Prozent der Patienten mit nichtorganischen Schlafst?rungen haben organische Zusatzdiagnosen und 77 Prozent der Patienten mit organischen Schlafst?rungen haben psychiatrische Zusatzdiagnosen (1). Deshalb ist es bei der medikament?sen Behandlung von Schlafst?rungen wichtig, nicht nur den Einfluss verschiedener Medikamente auf die Schlafqualit?t und -architektur zu kennen, sondern auch ihren Einfluss auf die peripheren Schlaf-Variablen hinsichtlich schlafbezogenen Atmungsst?rungen und n?chtlichen Bewegungsst?rungen zu beachten, um nicht mit der Behandlung der einen Schlafst?rung eine andere - koexistente - Schlafst?rung zu verschlechtern und eine Besserung zu verhindern.     

Eine Schlafstörung kommt selten allein

In the clinical routine insomnia disorders are often merely seen as symptoms of the underlying disease and are therefore not considered relevant enough for diagnostic clarification and initiation of specific treatment. The following article intends to give an overview of the differential diagnosis of nonorganic insomnia and underlines the importance of cognitive behavioral therapy in this context, which is substantiated by two case studies.     

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.     

Eine ungewöhnliche Störung der Farben- und Konturwahrnehmung

Ohne Zusammenfassung Bryn Mawr College Mit 2 Textabbildungen.     

Psychodynamische Kurzzeittherapie bei dependenter und vermeidender Persönlichkeitsstörung

Although dependent and avoidant personality disorders are frequent in patient populations, there are only few studies in which the efficacy of psychotherapeutic interventions for these two personality disorders was reviewed. The purpose of this study was to examine whether psychodynamic short-term therapy based on the model of the cyclic maladaptive pattern (CMP) is effective for reducing the mental impairment of patients diagnosed with a dependent or an avoidant personality disorder. Data were collected via a self-report scale (Symptom-Checklist, SCL) and expert ratings by therapists [Global Assessment of Functioning (GAF) Scale and Severity of Impairment-Score (Beeinträchtigungsschwere-Score, BSS)]. In the study 20 patients received 25 sessions of outpatient therapy. Mental impairment decreased significantly from the beginning to the end of the therapy; moreover this decrease remained stable over a 2-year period following completion of the therapy. The findings show that psychodynamic short-term therapy can lead to an enduring improvement in the mental health of patients with a dependent or an avoidant personality disorder.     

Traumatische Erfahrungen und Posttraumatische Belastungsstörung bei Journalisten

A questionnaire study on work-related trauma of journalists was conducted on the internet. 61 journalists (22 women) provided information about the type and frequency of highly stressful assignments and traumatic life events, symptoms of post-traumatic stress disorder (PCL-C), depression (CES-D) and coping style (emotional competence, FAPK, 3; sense of coherence, SOC). 46% of the participants lived in the USA, 41% in Europe; their mean age was 37 years and they had an average job experience of 13 years. They reported an average of 81 assignments in which they had been confronted with seriously injured, dying or dead persons or had worked at the risk of their own life. 13% had developed a full and 15% a partial post-traumatic stress disorder (PTSD). Compared to less disturbed individuals, the participants with (full or partial) PTSD reported significantly more often about violence in their original families, depressive symptoms and deficiencies in their emotional competence.     

„Neglekt“ bei der Aufmerksamkeitsdefizit-und-Hyperaktivitäts-Störung

They say he is an attention-deficit hyperactivity disorder (ADHD) child. He cannot engage in anything and cannot even play as normal. At home fierce and very loud power struggles are frequent. He has no friends, mostly he is sitting alone before his computer and he has no other interests. He suffers from sleep disturbances, he sleeps only with the light on, he comes often into the bed of the parents, where he makes a fuss. What does this child have? Is he only ill-bred? Is he anxious – at school or at home? Does he suffer from separation? Or is it a matter of a genetic development problem? The strange phenomenon of “neglect” is traced here in connection with the diagnosis of an ADHD. Lopsided considerations are implicitly connected with this disorder and entice to neglect the developmental disorder in its real cognitive and somatic complexity. In a critical review of biomedical and psychodynamical models, it becomes apparent that newer concepts and results in research are, beside further illuminating this disorder, also helpful for the therapy of these children. Finally, a detailed discussion of the specificities of a psychodynamic developmental therapy follows.     

Schlafstörung

A 41 year-old woman presented with restlessness and constricting and pressing dysesthesia in both calves and feet. These symptoms bother her especially in the evening while watching TV and later while lying in bed. She has to stand up repeatedly and walk around in her flat to obtain some temporary relief of her symptoms, which first appeared during her pregnancy 6 years ago and have become gradually worse over time. The patient complains that nowadays she lies awake in bed for up to 2 h until she can go to sleep several times a week. She wakes up 2–3 times a night only to find herself fighting to go back to sleep. During the day she noticed difficulties concentrating during work and frequently reacts angrily towards her husband and her daughter.     

Differenzialdiagnose schizoaffektive Störung versus bipolare Störung

This case presentation describes a 22-year-old woman after an episode of psychotic mania. Manic-psychotic and depressive episodes, partially with psychotic symptoms, and different diagnoses have been documented for the past 5 years, raising the question of the differential diagnosis between bipolar disorder and schizoaffective disorder. Depending on the classification (ICD-10 versus DSM-5), schizoaffective disorder is defined differently. According to ICD-10, schizoaffective episodes can be diagnosed when affective and schizophrenic symptoms occur simultaneously. In a different approach, DSM-V requires psychotic symptoms in the absence of major mood episodes for at least 2 weeks in the course of the disorder.     

Narzisstische Persönlichkeitsstörung

Narcissism is a multifaceted term which encompasses traits of normal personality as well as a specific personality disorder. While much research has been concerned with narcissism as a trait there are only few empirical studies on narcissistic personality disorder (NPS). The current diagnostic system of NPS according to DSM-5 (section II) focuses on grandiose narcissism whereas vulnerable narcissism, which is emphasized by clinicians and researchers, has not yet been recognized. While treating NPD patients an increased suicide risk has to be taken into consideration. Psychotherapy of narcissistic patients mainly focuses on processes during patient-therapist interactions, the analysis and processing of grandiose and vulnerable schemas, emotion regulation techniques and a correction of narcissistic behavior in favor of prosocial interactions.