Management der Parkinson-Demenz und Demenz mit Lewy-Körperchen

Idiopathisches Parkinson-Syndrom mit Demenz (PDD) und Demenz mit Lewy-K?rperchen (DLB) sind partiell unterschiedliche Manifestationen des Spektrums der Lewy-K?rperchen- und Alzheimer-Erkrankungen. Die Kombination von motorischer Parkinsonsymptomatik mit Demenz, affektiven St?rungen (Depression, Angst), Verhaltensst?rungen (wie REM-Sleep Behaviour Disorder) und psychotischen Episoden (Halluzinationen, Wahn, Delir) neben einer Reihe vegetativer Symptome und zunehmendem Nebenwirkungsrisiko erfordern eine ma?geschneiderte, sorgf?ltige, kombinierte Pharmakotherapie (L-Dopa mit Decarboxylasehemmer, gegebenenfalls Entacapone oder Tolcapone, neuere Antidepressiva wie SSRI, NaSSA, SNRI, Clozapin, Clonazepam, Therapie vegetativer St?rungen) und engmaschige klinische Kontrollen.     

Lärmendes Verhalten und störende Lautäußerungen bei Patienten mit Demenz

Loud behavior and disruptive vocalizations occur relatively frequently in patients with dementia together with agitation and other behavioral problems. An unambiguous diagnosis is important to take targeted therapeutic measures. First, nonpharmacological measures should be tried and the triggering stressors should be identified and eliminated if possible. Guidelines for the treatment of behavioral disorders, thus also for loud behavior, recommend behavioral therapy, cognitive–emotional training, sensory stimulation therapy, and psychosocial interventions. Targeted therapeutic measures can provide relief for the person with dementia and the relatives and nurses.     

Psychoedukation bei Personen mit erh?htem Psychoserisiko

Background

So far only few studies are available which have evaluated the effectiveness of psychoeducation for individuals at risk of psychosis in the early initial prodromal state (EIPS) whereas the benefit of psychoeducation in psychotic patients has been repeatedly confirmed. Thus the aim of this study was to investigate the effect of psychoeducation in individuals with increased risk of psychosis in the EIPS.

Method

A total of 128 help-seeking outpatients in the EIPS participated in a randomized controlled multicentre trial of 12 months of either psychoeducation as part of an integrated psychological intervention (IPI) or supportive counseling (SC). The time to transition to psychosis at 12-month and 24-month follow-up as well as the social adjustment at baseline, time of transition or post-treatment by means of the social adjustment scale (SAS?II) were assessed.

Results

The IPI was superior to SC in preventing progression to psychosis at 12-month (3.2% versus 16.9%, p?=0.008) and 24-month follow-up (6.3% versus 20.0%, p?=0.019). Both treatments resulted in significant pre-post improvements in SAS?II with no significant differences between the two groups.

Conclusions

Psychoeducation as part of an integrated intervention is effective for preventing the onset of psychosis over a 24-month time period in people in an EIPS. Moreover patients at risk of developing first episode psychosis seem to benefit from a specific psychoeducational intervention in the context of other treatments as well as from SC.     

Wie arbeite ich wirklich mit einem Traum?

According to Jung major impulses for psychic development and therefore for dealing with conflicts accrue from the unconscious in the form of dreams. In this article it will be shown as clearly as possible how a dream was dealt with in the therapeutic relationship.     

Misserfolge in der station?ren Therapie von Patienten mit Pers?nlichkeitsst?rungen

While psychotherapy has proven its efficacy and effectiveness in the treatment of personality disorders (PD) there is a lack of studies on treatment failure, i.e. non-response or deterioration of psychopathology. In a naturalistic approach the failed treatment of1,239 inpatients with PD was studied by means of direct and indirect assessment of change from patient and therapist perspectives. For indirect assessment the global severity index of the symptom checklist SCL-90-R (self-report by patients) and the impairment severity score (judgement by therapists) were used. Depending on the method between 11% and 31% of inpatients did not show any relevant improvement in symptoms but concordance between the methods was poor (Cohen’s kappa between 0.10 and 0.30). Patients with treatment failure did not differ from those with successful treatment with respect to sociodemographic and clinical features. The findings are discussed with respect to methodological limitations but also reflect possible clinical and therapeutic implications as well as future research approaches.     

Evidenzbasierte Psychotherapie der Panikst?rung mit und ohne Agoraphobie

From the evidence reported in the recent guidelines [Heinrichs et al. (2009) Evidenzbasierte Leitlinie zur Psychotherapie der Panikst?rung mit und ohne Agoraphobie. Hogrefe, G?ttingen] the following conclusions can be drawn with respect to the treatment of panic disorder with or without agoraphobia, as well as for agoraphobia without panic disorder:

1. Every psychotherapy should be preceded by suitable diagnostics and a case formulation.
2. The effectiveness of every psychotherapy should be evaluated with well established measures.
3. For the treatment of panic disorder without agoraphobia, cognitive behavioral treatment (CBT) and applied relaxation have been shown to be effective (evidence grade 1).
4. For panic disorder with agoraphobia, CBT, combination treatment (CBT plus medication), as well as panic-focused psychodynamic psychotherapy in the outpatient setting have shown short-term effectiveness (evidence grade 1). Longer lasting effects have been documented for CBT (evidence grade 1).
5. For agoraphobia without panic disorder, CBT with a focus on situational exposure can be recommended (evidence grade 1).

     

Kriminogene Entwicklungsrisiken von Jugendlichen mit Zuwanderungsgeschichte und M?glichkeiten der Pr?vention und Intervention

The higher rates of violence in the group of juveniles with a migrational background play a prominent role for criminology as well as for pedagogical and social practice in Germany. The following article gives an insight into some environmental and personal risk factors of this group, which could be responsible for their higher susceptibility to violence and delinquency. In the next step some conceptual questions of prevention and intervention are identified and illustrated with existing practical examples. Finally, the author makes some suggestions for further ways of violence prevention and analyzes the efficacy and ways of optimizing the existing programs for young migrants and their families.     

Konzeption zum Umgang mit rückfallgef?hrdeten Sexualstraft?tern (KURS NRW)

The concept of the management of sexual offenders at risk for recidivism in Northrhine-Wesfalia (Konzeption zumUmgang mitrückfallgef?hrdetenSexualstraft?tern in Nordrhein-Westfalen, KURS NRW) came into effect on February 1, 2010 with a joint circular of the Ministries of Justice, Health and the Interior. Thereby Northrhine-Westfalia has created a systematic for monitoring sexual offenders at risk for recidivism, comparable to those already or in the meantime developed in other federal states in Germany. This article initially describes the procedural nature underlying the KURS concept, regarding mutual information routing and collaboration between the parties involved, i.e. justice, hospital order treatment, police and if necessary others as well. In addition, the framework in which KURS is ingrained, will be shown. Based on case reports this article will finally explain how actions and reactions will be specified in case conferences. Within the systematic KURS it is important that all participants reach all relevant information expeditiously, thus being able to react within their own jurisdiction. When planning actions it is essential to carefully consider the individual case parameters. Within the case conferences it remains a strength of the KURS concept that different perspectives of the case and the offender are bundled together. Ideally this and the case-specific actions will help to avoid similar offences to those committed previously.     

Wie können Langzeittherapien mit kürzeren Behandlungen verglichen werden?

Long-term psychotherapy is not recommended in the current guidelines, which are based on the criteria of evidence-based medicine, as there is a lack of confirmation for long-term psychotherapy by efficacy studies. Using the example of psychoanalytic long-term psychotherapy this article describes six dilemmas which impede the realization of efficacy studies for long-term psychotherapy. Finally, basic elements of a study design are proposed, which are considered as being adequate to compare (psychoanalytic) long-term psychotherapy with shorter treatment forms in terms of outcome and cost-effectiveness. The anxiety and personality disorders (APD) study is briefly described as an example of a study realizing the proposed design.     

Umgang mit sexuellem Missbrauch Minderj?hriger durch Kleriker, Ordensleute und andere Mitarbeiter

The guidelines of the Catholic Church from 2010 have picked up on new findings and experiences which have arisen since the first guidelines from 2002. The necessity of a forensic psychiatric assessment of the prognosis or the credibility has been emphasized for the first time. The disjuncture of therapy and control will be considered as well as the basic obligation to report sexual abuse to the authorities if there are strong indications for a suspicion, except when there is a complete denial by the assumed victim. The history of guidelines in connection with the changing scientific, social and clerical judgement of pedosexual contacts will be discussed.     

Grammatik mit Widersprüchen

This paper presents and discusses important aspects of Optimality Theory, which has become one of the dominant models in theoretical linguistics. Optimality Theory is a system of constraints that are potentially in conflict with each other. Conflicts are resolved by ordering the principles in a strict hierarchy. We show that there are many respects in which Optimality Theory is a much more restrictive model of the language faculty than any of its competitors. Furthermore, the implications of the specific way how OT resolves conflicts seem to be more or less correct for natural language. However, modifications may be called for with respect to graded grammaticality and ineffability.     

Patientin mit komplexer somatoformer Schmerzstörung

Ohne Zusammenfassung     

Musiktherapie bei Kindern mit Migräne

Migraine in childhood is a serious health problem with a tendency for chronification. According to the bio-psycho-social model migraine is considered as a disorder generated by multiple factors and requiring an interdisciplinary treatment concept consisting of both medical and psychotherapeutic interventions. Music therapy as a nonverbal, creative arts therapy is especially apt for the treatment of children. A specific treatment concept in music therapy for children with migraine, to be applied within a multidisciplinary framework, and its theoretical background are presented in this article. Music therapy is firmly established within the context of stationary infant psychiatric care. Also, it is presently used as a method of outpatient psychotherapy mainly for children and adolescents. Additionally, music therapy finds frequent use in medical care, special needs education and curative education for children. This article will be limited to the presentation of music therapy as artistic psychotherapy.     

Autoimmun-Enzephalitiden – eine Erkrankungsgruppe mit vielen Gesichtern

During the last 10 years a number of syndromes with antibodies against neuronal surface antigens have been characterized. Adults as well as children can be affected. Patients may suffer from amnestic syndrome, other cognitive deficits, seizures, or psychiatric symptoms. Some patients develop generalized encephalopathy with altered levels of consciousness, hyperkinesias, and hypothalamic disorders. In some patients, ovarial teratoma, thymoma, or small cell lung cancer can be diagnosed. However, in most patients no tumor is found. These syndromes were previously called autoimmune channelopathies. In fact, most antigens are not part of an ion channel but proteins or part of protein complexes on the cell surface of neurons, axons, dendrites, or synaptic terminals. These proteins are expressed throughout the nervous system. Interestingly, in limbic encephalitis very circumscribed brain regions are affected. This may be due to an increased vulnerability or accessibility of the affected brain regions. Limbic encephalitis is a well-characterized form of autoimmune encephalitis, which can be associated with different antibodies. Anti-NMDA-receptor encephalitis is not restricted to the limbic system. Characterization of other syndromes and auto-antibodies are expected in the future. In this review, aspects of limbic encephalitis and anti-NMDA-receptor encephalitis will be discussed.