Dissoziative Störungen (Konversionsstörungen)

The ICD-10 diagnostic category of dissociative disorders encompasses very different clinical pictures. The so called dissociative disorders of consciousness are characterized by functional disturbances to the psychic domains of consciousness, identity, autobiographic memory and experience of self and the world. The core features of conversion disorders are functional alterations in the sensorimotor systems. The phenomenological heterogeneity is reflected by prevalence rates ranging from very rare to 30% in clinical populations. Traumatic experiences play a crucial role in the etiology and pathogenesis of these disorders. High rates of comorbid disorders, a tendency to a chronic course and a somatic illness concept in patients with conversion disorders complicate the psychotherapeutic approach. Depending on the therapeutic goals, both psychodynamic and cognitive-behavioral treatment forms are suitable.     

Behandlungsleitlinie Persönlichkeitsstörungen

The S2 guidelines for the treatment of personality disorders (PD) are summarized. In the diagnostic assessment of personality disorders a clinical interview should be supplemented by (semi-) structured clinical interviews and self-report measures for the categorical and dimensional assessment of PDs. The results of the assessment process should be communicated to the patient based on a psycho-educational framework. The diagnosis should always be linked to the patient’s individual history. Psychotherapy is the treatment of choice for personality disorders. A detailed analysis of the patient’s problems as well as the definition of a hierarchy of treatment goals are part of the process of treatment planning. For three PDs empirical evidence for treatment approaches is available: (1) dialectical behavior therapy, mentalization-based therapy, schema focused therapy and transference focused therapy all proved beneficial in the treatment of borderline personality disorder. Cognitive-behavior therapy proved helpful in the treatment of (2) dissociative personality disorder and (3) avoidant personality disorder. There is limited evidence for interpersonal therapy and psychodynamic therapies in the treatment of avoidant personality disorder.     

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.     

Glaubhaftigkeitsbegutachtung bei Persönlichkeitsstörungen

Credibility assessment of incriminating declarations by witnesses with a personality disorder have become an increasingly important topic of statement psychology over the past years. Relevant problems along the assessment process and arising questions as well as consequences for jurisdiction are discussed.     

Diagnostik von Persönlichkeitsstörungen

Diagnosing and classifying personality disorders is complex and difficult from both the scientific and clinical perspectives. Dimensional and categorical models and assessment instruments of personality disorders, and different (behavioral and psychodynamic orientated) clinical procedures are described. Furthermore, an integrative view on clinical practice is presented.     

Psychopharmakotherapie der Essstörungen

Es gibt eine Reihe von Studien zur Pharmakotherapie der Essst?rungen. Empfehlungen für die pharmakologische Behandlung von Essst?rungen (Anorexia nervosa (AN), Bulimia nervosa (BN), Binge Eating Disorder (BED)), basierend auf der verfügbaren Literatur, werden vorgestellt: Für AN gibt es Hinweise, dass eine ,,Zinksupplementierung“ oder der Einsatz von atypischen Antipsychotika hilfreich sein kann. Für BN zeigen die Studien positive Ergebnisse hinsichtlich des Einsatzes von Antidepressiva, insbesondere für Fluvoxamin und Fluoxetin. Auch für das Antiepilektum Topiramat gibt es positive Studienergebnisse. Bei BED k?nnen bestimmte Antidepressiva und Antiepileptika erfolgreich eingesetzt werden. Jedoch wird weitere Forschung für die Verbesserung der Behandlung von Essst?rungen ben?tigt. Speziell für Anorexia nervosa besteht ein Bedarf für weitere pharmakologische Behandlungsstrategien.     

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.     

Psychotherapie von Anpassungsstörungen

In this study we examined the effectiveness of an outpatient client-centered psychotherapy of patients with adjustment disorders (ICD-10 F43.2) limited to twelve sessions in comparison to an untreated control group. The patients of each group (n_treatment= 31 and n_control= 19) had been diagnosed with an adjustment disorder in response to one of the following stressful events: either the loss of an important person or performance deficits at work or university. Compared with the untreated control group the immediate therapy group improved significantly on rating scales and questionnaires. These positive treatment effects proved stable at a 3 months follow-up. Individual treatment gains were also analyzed for clinical and statistical significance. The improvements of the treatment group were significantly greater in all used measures than those of the control group. These improvements were interpreted as an effect of the client-centered treatment which resulted in high individual overall treatment gains and in high effectsizes.     

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.     

Die Behandlung von Borderline-Persönlichkeitsstörungen

Zusammenfassung Bereits 1681 beklagte sich ein englischer Arzt in einem Brief über Patienten, die ohne jedes Ma? jene lieben, die sie alsbald ohne jeden Grund hassen würden. Weiterhin seien pl?tzliche Ausbrüche von Wut, Schmerz, Angst oder ?hnlichen Emotionen zu beobachten. Mit dieser frühen Beschreibung typischer Borderline-Symptome wird die Darstellung der Entwicklung der Theorie der Borderline-St?rung von den Anf?ngen bis heute eingeleitet. Vor diesem Hintergrund werden der Stand der Diagnostik und die derzeit wichtigen Behandlungskonzepte umrissen, und zwar die psychodynamischen, verhaltenstherapeutischen und klientenzentrierten Ans?tze. Es wird dargelegt, welche Antworten es auf die Frage gibt, was das angemessene therapeutische Setting ist, insbesondere mit Blick auf station?re Behandlungskonzepte. Die vorliegenden empirischen Studien best?tigen die Wirksamkeit von Psychotherapie bei Borderline-St?rungen. Die geringe Zahl der Studien belegt aber auch die Schwierigkeit der empirischen Forschung in diesem Bereich. Der abschlie?ende Ausblick in die Zukunft der Psychotherapie der Borderline-Pers?nlichkeitsst?rungen prognostiziert eine weitere Zunahme von Pers?nlichkeitsst?rungen im Spektrum psychiatrischer Erkrankungen und eine zunehmende Differenzierung des Behandlungsangebots bzw. Spezialisierung der Behandler.