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.     

Response und Non-Response in der station?ren Psychotherapie depressiver Patienten

Background

Poor outcome of psychotherapeutic treatment has not yet been sufficiently investigated. It is assumed that approximately 25–30% of patients are treatment non-responders and about 5–10% suffer deterioration.

Study design and methods

The therapeutic success of a total of 2,323 consecutively admitted inpatients with a depressive episode (F32.0-2, F33.0-2) was evaluated by using different strategies based on self ratings at admission and at discharge, i.e. the Beck depression inventory II (BDI-II) and the brief symptom inventory (BSI). In intention to treat (ITT) and completer analyses various measures of therapy success were compared (e.g. statistical significance, effect sizes and clinical significance).

Results

Effect sizes were 1.59 (BDI-II) and 0.86 (BSI) for the ITT sample and 1.64 and 0.89 for the completer sample. Analyses using criteria of clinical significance resulted in response rates of 75.5% (BDI-II) and of 68.7% (BSI) for completer analyses and remission rates of 62.2% (BDI-II) and of 40.8% (BSI). Non-Response rates, also including minor responders, varied between 23.4% (BDI-II) and 27.4% (BSI). Deterioration was observed in only 1% (BDI-II) and 3.9% (BSI) of the patients.

Discussion

The results demonstrate that about two thirds of depressive patients show clinically significant improvements within a multimodal, primarily psychotherapeutic inpatient setting, whereas the rates of deterioration are lower than expected. The aim for the future should be to identify poor or minor response as early as possible in order to optimize treatment.     

Mehr Liebe und weniger Gewalt?

This contribution analyzes changes in the role of fathers, which are embedded in overall social changes and changes in parental attitudes and behavior. It shows a trend towards paternal warmth and involvement and a tendency to avoid paternal functions related to dealing with the child??s aggression. The decrease in power and authority has, however, resulted in an increase of psychological control, which is detrimental for the child??s outcome. Today, many fathers face the dilemma of combining work and paternal duties. In particular, fathers of small children are confronted with the breadwinner function and the highest work load, compared to fathers of older children. In general, diversity in fathers?? roles has increased with a high number of traditional fathers and also fathers who were able to balance work and family; ??new fathers?? are not frequent at all. The consequences for therapeutic work are discussed.     

A power-law model of psychological memory strength in short- and long-term recognition

A classic law of cognition is that forgetting curves are closely approximated by power functions. This law describes relations between different empirical dependent variables and the retention interval, and the precise form of the functional relation depends on the scale used to measure each variable. In the research reported here, we conducted a recognition task involving both short- and long-term probes. We discovered that formal memory-strength parameters from an exemplar-recognition model closely followed a power function of the lag between studied items and a test probe. The model accounted for rich sets of response time (RT) data at both individual-subject and individual-lag levels. Because memory strengths were derived from model fits to choices and RTs from individual trials, the psychological power law was independent of the scale used to summarize the forgetting functions. Alternative models that assumed different functional relations or posited a separate fixed-strength working memory store fared considerably worse than the power-law model did in predicting the data.     

Coming to terms: quantifying the benefits of linguistic coordination

Sharing a public language facilitates particularly efficient forms of joint perception and action by giving interlocutors refined tools for directing attention and aligning conceptual models and action. We hypothesized that interlocutors who flexibly align their linguistic practices and converge on a shared language will improve their cooperative performance on joint tasks. To test this prediction, we employed a novel experimental design, in which pairs of participants cooperated linguistically to solve a perceptual task. We found that dyad members generally showed a high propensity to adapt to each other's linguistic practices. However, although general linguistic alignment did not have a positive effect on performance, the alignment of particular task-relevant vocabularies strongly correlated with collective performance. In other words, the more dyad members selectively aligned linguistic tools fit for the task, the better they performed. Our work thus uncovers the interplay between social dynamics and sensitivity to task affordances in successful cooperation.     

Explaining delusions of control: the comparator model 20 years on

Over the last 20 years the comparator model for delusions of control has received considerable support in terms of empirical studies. However, the original version clearly needs to be replaced by a model with a much greater degree of sophistication and specificity. Future developments are likely to involve the specification of the role of dopamine in the model and a generalisation of its explanatory power to the whole range of positive symptoms. However, we will still need to explain why symptoms can be so variable and we still do not understand the origin of the most mysterious symptom of all: thought insertion.