Entspannungsverfahren

Autogenic training, progressive relaxation and hypnosis show good empirical evidence as relaxation-therapies and are useful techniques in psychotherapy and also in behavioral therapy and psychiatric treatment. Relaxation therapy can be used on its own in psychosomatic concepts of e.g. internal medicine and it is a well established and scientific-based component in the treatment of psychic, psychosomatic or psychiatric disorders, except psychosis and severe dementia. Though in details somewhat different, the methodology of these techniques creates a framework, in which the psychophysiologically determined relaxation response is easily elicited. However, regular practice of the patients is required. Focussed attention, imagination and new attributions of bodily or mental perceptions play a dominant role.The task of the modern “relaxation-therapist” doesn’t consist in charismatic guided exercises but in enhancing the patient’s motivation for searching his own way of relaxation. Relaxation can be combined with all psychotherapeutic (including psychodynamic) and psychiatric treatments. For our patients’ benefit a widespread application of these techniques should be practiced.     

Die psychosomatische Triangulierung

Zusammenfassung   Das Konzept der psychosomatischen Triangulierung bietet einen entwicklungsorientierten Ansatz für das Verst?ndnis psychosomatischer Symptombildungen. Der Begriff wurde von Peter Kutter eingeführt, stie? jedoch, im Gegensatz zum Konzept der frühen Triangulierung, nicht auf bleibende Resonanz. Geht es in Kutters Modell der psychosomatischen Triangulierung um ein Geschehen im Dreieck zwischen dem Kind, dem K?rper des Kindes und der Mutter, in dem sich das Kind seinen K?rper aneignet und damit einen Schritt der Abl?sung von der Mutter vollzieht, so tritt im Dreieck der frühen Triangulierung der Vater oder ein anderer Dritter von au?en zur Mutter-Kind-Dyade hinzu und erm?glicht Losl?sung und Individuation. Es wird zun?chst gezeigt, dass der Begriff der psychosomatischen Triangulierung zweierlei bezeichnen kann, zum einen als gelungene psychosomatische Triangulierung einen Entwicklungsschritt, zum anderen bei einer misslungenen frühen Triangulierung eine Notl?sung, in der der K?rper an die Stelle des Dritten tritt. Eine Untersuchung der mit der Aneignung des eigenen K?rpers verbundenen Vorg?nge der Affektspiegelung und der Symbolisierung erweitert dann das Konzept der psychosomatischen Triangulierung und erm?glicht eine Verknüpfung mit den therapeutisch relevanten Vorstellungen über Prozesse der semiotischen Regression und Progression. Es zeigt sich, dass unabh?ngig davon, ob der K?rper in der psychosomatischen Symptombildung symbiotisch, übergangsobjekthaft oder symbolisch verwendet wird, die Suche nach M?glichkeiten, eine dyadisch abgeschlossene Konstellation zu einer triadischen zu erweitern, zu semiotischer Progression und Entwicklung führen kann.

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Psychosomatic triangulation

Abstract   The concept of psychosomatic triangulation provides a developmentally based perspective in order to understand the dynamics of psychosomatic symptoms. Originally introduced by Peter Kutter, this concept lacked – in contrast to that of early triangulation – a long-lasting resonance. Whereas Kutter's model focused on the triangle of child, the child's body and the mother, in which the child gradually acquires its own body and thus undertakes steps towards the separation from the mother, in the process of early triangulation the father, or another significant third person, joins the mother-child dyad and facilitates separation and individuation. First, it will be shown that the concept of psychosomatic triangulation means two things: on the one hand it is a successful psychosomatic triangulation as a developmental step, on the other hand it can also mean a stop gap solution if early triangulation has failed and the body takes the role of a third person. A survey of processes of affect reflection and symbolisation which develop on the way to acquiring the body, widens the concept of psychosomatic triangulation and provides us with a deeper understanding of ideas of regression and progression which are mainly clinically relevant. It will be shown that regardless of whether in psychosomatic symptom formation the body is used in a symbiotic, transitional or symbolic way, the search for possibilities to widen the dyadic constellation into a triadic one can lead to semiotic progression and development.

     

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.     

The structure of psychosomatic symptoms

1. According to our findings, a psychosomatic structure is not an alternative to neurosis. The syndrome of alexithymia appears to be, in our cases, a transitional phase, the dynamics of which can be understood and treated by psychotherapy. In the course of psychotherapeutic treatment, alexithymia always disappears. 2. However, a special psychotherapeutic technique is advisable, one different from that applied in classical neurosis. 3. For this reason the term psychosomatic structure can be used as a way of expressing a variation of neurosis. 4. Modern concepts of psychosomatic disease describe pathological personalities that are different from the classic pseudoneurotic type because of their narcissistic and pregenital structures. These structures can be concealed underneath a facade of genital and psychoneurotic defense. 5. The old relationship between psychosomatosis and psychosis can be better understood on the basis of our findings, which reveal a borderline structure and splitting mechanisms in many psychosomatic patients. 6. Psychosomatic pathology can be better understood today by relating it to the structure of the psychosomatic family. 7. It appears that if, on the one hand, psychosomatic diseases of a more hysterical picture are frequent among preindustrial cultures and in low-income classes, on the other hand psychosomatic syndromes of a narcissistic and borderline type are characteristic for our civilization.     

Gruppenpsychotherapie

Group therapy treatments represent a most suited treatment option for a broad spectrum of psychological disturbances in the field of psychosomatic, psychiatric and somatic diseases. For some distortions and problems group therapy is the preferential treatment: personality disorders, substance abuses, eating disorders, psychiatric and chronic somatic diseases. The broad indicational options of the group setting are widely unknown, but they certainly need careful preparations and indicational decisions.     

Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.     

The Use of Psychoeducation for a Patient with Hepatitis C and Psychiatric Illness in Preparation for Antiviral Therapy: A Case Report and Discussion

The standard of care treatment for chronic hepatitis C viral infection (HCV) is a combination of pegylated interferon alfa and ribavirin for 24-48?weeks according to the virus genotype. This therapy is known to have multiple neuropsychiatric side effects. A major concern when evaluating a patient for HCV treatment with a known history of a psychiatric disorder is the risk that the patient's psychiatric disorder will flare or become unmanageable. The possibility of precipitating depression, confusion, mania, psychosis, hallucinations, or suicidal ideation or attempt is frequently an obstacle to treatment. We present the case of a 50?year-old man with HCV and an extensive psychiatric history involving alcoholism, depression, and suicidality who participated in a psychoeducation group to help prepare him for treatment with pegylated interferon alfa/ribavirin therapy. Though the patient derived much benefit from the psychoeducation group, by the time of evaluation for HCV treatment two months after the group ended he had relapsed back into a depressive episode with suicidal thoughts. His acute psychiatric status made him unacceptable for pegylated interferon alfa/ribavirin therapy. Psychoeducation groups show promise for helping patients with chronic medical illness to be ready for and endure intensive medical treatment that has substantial psychiatric side effects. The challenge is to help patients overcome barriers to treatment, particularly psychosocial problems, because available treatments are increasingly effective.     

Comparison of Rorschach anatomy responses from psychosomatic out-patients and a matched group of psychiatric controls.

35 out-patient Ss with demonstrable psychosomatic symptoms were matched with 35 psychiatric out-patients with "milder" forms of psychopathology, i.e., neurosis, personality disorders and latent schizophrenia. The psychosomatic group showed significantly more anatomy responses on the Rorschach but there was much overlap, leading to the conclusion that anatomy does not directly reflect simply psychosomatic disturbances but, rather, is associated with psychodynamics which tend to underlie psychosomatic illnesses.     

Psychosomatik in der Dermatologie

Psychosomatic dermatology deals with skin disorders that are substantially influenced by psychosocial causes, sequelae or circumstances or in which these are important in the selection of therapy for the particular patient. In this context, skin diseases have been recognized in a biopsychosocial model for holistic medicine. In a wider sense, psychosomatic dermatology embraces every aspect of intra- and interpersonal problems relating to skin disorders and psychosomatic trigger mechanisms and/or ways of coping with skin disorders. A distinction is made between primarily psychic conflicts, psychosomatic diseases and somatopsychic aspects. Approaches to treatment take account of the doctor (doctor’s–assistant)–patient relationship, compliance factors, the dermatosis patient’s quality of life and the psychosocial health of the dermatologist, and also steps that can be implemented in the context of the practice management and basic psychosomatic treatment including referral for special psychotherapy     

Protection by drugs and psychotherapy against delayed psychosomatic responses: The role of positive autokinesis

This paper presents an interpretation of the delayed psychosomatic response and how it can be therapeutically alleviated by drug administration or by psychotherapeutic acquisition of insight. If the delayed psychosomatic response is indeed related to Gantt's negative autokinesis in dogs, it should ultimately become amenable to treatment based on the concept of positive autokinesis. Psychotherapy henceforth should put more emphasis on the learning processes, if only because the learning processes, as visualized in positive autokinesis, may be required to make drug therapy more effective. For all practical purposes the placebo effect can be considered a real effect proceeding from changes in neurochemical processes triggered by the belief of the patient.     

Der Arztbrief

The right of inspection in the hospital documents, the hospital discharge report for example, is often refused to patients in in-patient psychotherapeutic treatment (psychiatry, psychosomatic and psychotherapeutic medicine) with reference to the protection of the patients themselves, their doctors or relatives. Within a systemic therapy approach patients of an acute psychosomatic care unit in a hospital the patients could inspect the report of their hospital treatment including all ?objective” and ?subjective” data of their hospital stay. The conversation with patients and their relatives about this report and modifications of the details and addresses of the report in case of patients’ objections is considered as a psychotherapeutic tool (narrative of doctor and patient) in order to improve the transparency of the diagnostic and therapeutic process and the insights in the psychosomatic mechanisms of the patient’s disease. We discuss our organisation of cocreating the hospital discharge report and our experiences with this type of patient-doctor-communication.     

Psychosomatische Frauenheilkunde

The psychosomatic perspective offers the adequate method in face of the particularities of gynaecologic tasks and the expectations of women. Every patient comes not only with her illness as an acute and pressing issue into the treatment situation, but brings with her the sum of her previous experiences about her own body and about the medical institutions. The more conscious the doctor-patient-relationship, the less the risk of violations of personal limits which could trigger interpersonal conflicts and problems. The gynaecologist accompanies the normal bodily development, too. So she/he is an advisor in various life-periods as adolescence, pregnancy and childbirth or the menopause and senium. This very special relationship between doctor and patient offered the ground for integrating psychosomatics into gynaecological practice. The theoretical basis of psychosomatic gynaecology includes several models which can be applied to the one or the other illness. We assume a complex, multifactorial and interdependent event where biological, organic, psychodynamic and sociological factors are interacting. From historical and feminist perspective interesting developments can be traced about "what makes women ill". Psychosomatic symptoms may be seen as disturbances of interpersonal relationships on the background of the indidvidual life history and they may be understood as socially co-determinated. For the theory of psychosomatic gynaecology this means, that the bodily, social and psychic differences between women and men should be considered and theoretically reflected. In the future, specific strains of women as expressed in psychosomatic-gynaecological symptoms need further investigation.     

Comorbidity of drug abuse treatment

Research has suggested that comorbidity, the concurrence of substance abuse disorders with other psychiatric disorders, may have prognostic value and important implications for the treatment of substance abuse. Knowledge of the prevalence of comorbid disorder is important because it will enable treatment services to be appropriately configured and designed for clinical drug treatment populations. The form and duration of comorbidity may be influenced by a variety of factors, which include the class of drug being abused, the duration of drug use, the individual sensitivity to drug effects, and whether the drug effects are acute or due to withdrawal or residual conditions. This paper addresses three important scientific questions: (1) What is the prevalence of comorbid disorders in a drug abuser population? (2) What is the stability of psychiatric diagnoses in a drug abuser population? (3) Does the existence of a comorbid disorder influence the outcome of drug abuse treatment?     

试论心身疾病的中医病机

心身疾病是指那些心理一社会因素在疾病的发生和发展中起重要作用的躯体疾病。其概念决定了心身疾病不具有专业领域性,不同心身疾病有着不同的病理变化。发掘其病理共性、找寻规律性,对该学科发展的标准化方向至关重要。该文从中医基本病机层次,探讨了心身疾病的发生、发展与变化的机理,试图对科研与临床操作提供有益思路。     

Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain

This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach.     

The animating body: psychoid substance as a mutual experience of psychosomatic disorder

Starting from Jung's hypothesis of 'the psychoid', the author suggests that the concept can be extended and understood as a dynamic, relational and interpersonal experience-especially in regressed analytic relations. The author then defines his use of the term 'animating body' as having to do with primitive animal imagery and with psychosomatic symptoms stemming from disturbed pre-verbal and pre-whole-object stages of development. A case of a borderline patient is presented, whose projective identifications into the analyst infected him with her psychosomatic disorder, with her internalized Oedipal confusion and necessarily induced a mutually similar animal dream symbolism. If these embodied countertransference experiences (of desperate merging and sickening identification) can be lived through (tolerated and survived), thought through and interpreted, then they can actually become enlivening and lead to a therapeutic psychosomatic co-ordination.     

Fallbeispiele zum Thema Burnout

Burnout is a process, in which dysfunctional interactions between a person and external stresses (professional, nonprofessional) play a central role in its development. It is accompanied by emotional and physical exhaustion, decreased productivity, and a negative attitude toward work, other stress factors, and people associated with work. Depressive disorders, anxiety disorders, other psychiatric and psychosomatic disorders, and physical and cognitive disorders are often observed as part of burnout. Differentiation from other (in particular psychiatric) diseases is mainly possible based on a history of a lengthy (months, years) process of development associated with external stress factors. This differentiation is essential to determine an appropriate, multiprofessional approach, in which drug treatment, psychotherapy, coaching, lifestyle modification, and methods of stress reduction are available and should be used in a coordinated manner.     

Therapieresistente Depression – eine differenzialdiagnostische Herausforderung

Background

Diagnosis and treatment of major depression is part of daily routine in psychiatric practice. We therefore rely on the latest ICD-10 and the described symptoms. However, is this decision always obvious, and which differential diagnostic considerations should be made, especially for patients with treatment-resistant depression or in elderly patients?

Method

A clinical case report is described, taking into consideration the results of a literature search and national and international guidelines.

Results

Major depression is usually part of daily routine in the psychiatric hospital. It is one of the most common diagnoses; the estimated lifetime prevalence of unipolar major depression is 12?% and continues to increase. But what should be done, if symptoms continue to deteriorate, despite guideline-based treatment? The following case report shows that in this situation further diagnostic procedures are needed and necessary. An 80-year-old man is transferred to a psychiatric ward because of depressive symptoms. Despite adequate treatment, the psychiatric state deteriorates. Finally, the diagnosis of normal pressure hydrocephalus (NPH) is made with the direct consequence of further treatment options. Especially the possible overlap of symptoms for depression, dementia, and NPH are shown, thus, making the differential diagnosis challenging.

Conclusion

In 80?% of cases, NPH remains unrecognized and untreated. Similarities in the symptoms lead to the difficulty of distinguishing NPH from other neurodegenerative disorders and, as in this case report, also from major depression. In case of NPH, early diagnosis and treatment are important because if the disease is too advanced, clinical improvement is unlikely. Therefore, in cases of treatment-resistant major depression it is advisable to perform additional diagnostic tests and to consult with interdisciplinary neurology and neuroradiology teams.     

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.     

Sculpting Present and Future: A Systemic Intervention Model Applied to Psychosomatic Families

We present a therapeutic intervention model for use with psychosomatic families. This method, the result of our extensive research on various psychosomatic disorders, uses family sculptures of the "present" and "future": each family member is requested to represent the family as it now "is," and how it "will be" in the future. We discuss the theoretical reasons for our choice of this method: (a) the opportunity to use a therapeutic language that is similar to the nonverbal language of the psychosomatic symptom, and (b) the usefulness of reinserting temporal dimensions into family systems that seem to have lost their evolutionary potential and to be in a sort of "time lock." Two clinical cases are discussed (a child with chronic asthma and an anorexic adolescent); the use of sculptures in both cases revealed the underlying problems and made positive therapeutic interventions possible. Finally, we point out how the use of sculpture as a therapeutic technique enables therapists to deal with multiple systemic levels.