An evaluation of crisis hotline outcomes. Part 1: Nonsuicidal crisis callers

The effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers' crisis state from the beginning to the end of their calls to eight centers in the U.S. and intermediate outcomes within 3 weeks of their calls, was evaluated. Between March 2003 and July 2004, 1,617 crisis callers were assessed during their calls and 801 (49.5%) participated in the followup assessment. Significant decreases in callers' crisis states and hopelessness were found during the course of the telephone session, with continuing decreases in crisis states and hopelessness in the following weeks. A majority of callers were provided with referrals and/or plans of actions for their concerns and approximately one third of those provided with mental health referrals had followed up with the referral by the time of the follow-up assessment. While crisis service staff coded these callers as nonsuicidal, at follow-up nearly 12% of them reported having suicidal thoughts either during or since their call to the center. The need to conduct suicide risk assessments with crisis callers and to identify strategies to improve referral follow-up is highlighted.     

Coercive and precocious sexuality as a fundamental aspect of psychopathy

Sexual behavior is closely associated with delinquency and crime. Although psychopaths, by definition, have many short-term sexual relationships, it has not been shown that sexuality is a core aspect of psychopathy. A Darwinian view of psychopathy led to the hypothesis that psychopaths have a unique sexuality involving early, frequent, and coercive sex. Our subjects were 512 sex offenders assessed on the Hare Psychopathy Checklist (PCL-R). Five variables reflecting early, frequent, and coercive sex loaded on the same principal component in exploratory factor analysis on a subset of the sample, whereas PCL-R items pertaining to adult sexual behavior did not. Confirmatory factor analysis of the remaining subjects yielded a measurement model containing three inter-correlated factors - the traditional two PCL-R factors, and coercive and precocious sexuality. Taxometric analyses gave evidence of a natural discontinuity underlying coercive and precocious sexuality. Coercive and precocious sexuality yielded statistically significant associations with other study variables predicted by the Darwinian hypothesis. The present findings are consistent with prior empirical findings and support the hypothesis that psychopathy has been a nonpathological, reproductively viable, alternate life history strategy.     

Stalking

An anti-stalking law, now common in many western countries, took effect in Germany in November 2006 (§238 Criminal Code; see Infobox). Stalking occurs when a stalker follows a victim for weeks or months and shows molesting, threatening or attacking behavior. Through the continual pursuit, the victims feel at the least extremely insecure and at times afraid; in extreme cases, stalking can lead to psychological disturbances. Our investigations have shown that about 10–15% of males and 15–20% of females are stalking victims at some stage of their lives. This contribution describes the different forms of stalking and discusses the various motives for this behavior, as well as the psychological problems of the victim. It also provides some first thoughts on the psychotherapy of both stalkers and victims.     

Affektverarbeitung und Beziehungsgestaltung bei somatoformen Störungen

Somatoform disorders are usually associated with disturbances in affective processing and consequently with relational disorders. The effect of psychotherapy on the emotional regulation and the relational behaviour in the course of treatment of a patient with somatoform autonomous dysfunction and dysthymia has been examined. Pre-post comparisons of inpatient treatment have been performed by means of standardized questionnaire data; the course of therapy has been evaluated by the analysis of the dependence of the leading symptom of hypogastric pain on mood parameters with the help of multivariate time-series analyses. One effect of psychotherapy was the initiation of an intrapsychic discourse, which led to an improved ability of affect regulation as well as to a better functioning in relationships. This was accompanied by a reduction of somatization. The interrelations between somatization, affect- and relationship-regulation are discussed.     

Studienbezogene Belastungen, Lebensqualität und Beziehungserleben bei Medizinstudenten

In a cross-sectional study of medical students we examined educational strains, health feeling, and relationship patterns. Work stress was measured using the questionnaire by Jurkat et al., health-related quality of life was measured using the Short Form- (SF-)36 Health Survey, and relationship patterns to the partner as well as to a friend were mapped using“Beziehungsmusterfragebogen“ (BeMus). Study stress was assessed as being high by 60% of the students. Consequently, 39% had not enough time for their partners und 29% had no time for own interests. The mental health averaged significantly below the norm. A high workload and discontent correlated with aggressiveness, especially in the partnership, whereas loving care towards the partner or friend correlated with a high level of satisfaction and a lower strain level. Therefore, an improvement of psychosocial competence in medical students as well as a practice-oriented preparation for the profession is needed.     

Leitlinie für die Begutachtung von Schmerzen

The present guidelines for expert testimony have been elaborated for the first time in 2004 by medico-legal representatives from several German professional academic societies (neurology, orthopedic surgery, psychiatry, psychosomatic medicine, psychotherapy). Their aim is to standardize the course and the content of expert testimony in subjects, who complain about chronic pain as the leading symptom for seeking pension or other compensation. In 2006, the guidelines have been revised and completed by adding detailed data about classification and prognosis of chronic pain, about causality questions, and about estimation of functional impairment in different legal areas.     

Fibromyalgie und Leistungseinschränkung

Interdisciplinary guidelines allowed for new quality standards in pain appraisal. Simultaneously, the scientific notion of fibromyalgia changed from a subjectively overvalued malaise to a central disturbance of coping with stress, which is neurobiologically determined. Therefore, in this article a psychosomatics-based guide is given for the socio-medical appraisal of fibromyalgia with reference to the new International Classification for Functioning and Disability (ICF) of the World Health Organization (WHO). As illustration a case study is presented.     

Counselling the dead!

The paper discusses the author's meeting and a counselling encounter in Varanasi (formerly known as Banaras) with a former High Court Judge, who has renounced the material world, excised all his attachments, abandoned his wife, his children, his grandchildren and a luxurious and prestigious life-style, and taken on the mantle of a sanyasi in search of enlightenment and nirvana. He has left his hometown and for the past two to three years has been living on the banks of the river Ganges in Varanasi, the holiest of holy cities in India, leading the life of a mendicant, living off the charity of the hordes of pilgrims who come to Varanasi all around the year.