Psychotherapeutische Kurzintervention bei somatisierenden Patienten im Krankenhaus

The manual describes the psychotherapeutic procedure for somatizing patients who are admitted to hospital for diagnostics and therapy of unclear physical complaints. An essential goal of the psychotherapeutic interventions is to achieve an understanding for the disease, in which body, psyche and social relationships are experienced as interrelated. By addressing the health fears and subjective concepts about the onset and maintenance of his physical complaints, the patient feels that he is being taken seriously and understood. Connections between physical symptoms and the suppression of undesirable affects like anger, rage and disappointment are verbalized and understood in greater depth, based on body perception exercises and a symptom diary. The positive experience of understanding and symptom relief obtained in the psychotherapeutic sessions is used for the main goal of the intervention: to motivate the (out- and in-)patient for a regular psychotherapy. Experience up to now has shown that three to five sequential sessions of about 45–60 minutes suffice to attain this therapy goal. Implementation is most successful within an established consultant or liaison service in close cooperation with the ward doctors.     

Tinnitus als soziale Infektion?

Background

11 out of 35 male employees of a central alert team with rescue coordination function developed a tinnitus disorder. This clinical case-study highlights the psychodynamic background of this accumulation.

Methods

Employees were investigated by psychometric questionnaires and semistructured psychodynamic biografical interviews. Additionally aspects of group dynamics and organisational structure were assessed.

Results

All staff members reported adverse work conditions. Medical and psychometric examination of the tinnitus patients did not reveal severe pathological findings. The interviews identified psychodynamic conflicts dealing with autonomy and regulation of self-esteem. All tinnitus patients reported a very adverse or punitive father relation and difficulties in performing a stabile male role and self-image. Group dynamics was dominated by paranoid and regressive tendencies complicated by maladaptive coping, crude perception of external facts and a pronounced experience of aggressive impulses.

Conclusion

The remobilisation of infantile powerlessness, ineffectiveness and helplessness triggered by adverse work conditions and the introduction of a new culture of personal responsibility within the work organisation together with an impaired coping of separation conflicts enforced by traumatic aspects of the relation with the father may have promoted the tinnitus symptomatology. Additionally, due to the missing awareness of the importance of such group dynamical processes the employers contributed to an increasing psychosocial distress, which promoted the accumulated manifestation of tinnitus as a conflict expressive symptom.     

Confounds in pictorial sets: The role of complexity and familiarity in basic-level picture processing

Complexity is conventionally defined as the level of detail or intricacy contained within a picture. The study of complexity has received relatively little attention-in part, because of the absence of an acceptable metric. Traditionally, normative ratings of complexity have been based on human judgments. However, this study demonstrates that published norms for visual complexity are biased. Familiarity and learning influence the subjective complexity scores for nonsense shapes, with a significant training x familiarity interaction [F(1,52) = 17.53, p < .05]. Several image-processing techniques were explored as alternative measures of picture and image complexity. A perimeter detection measure correlates strongly with human judgments of the complexity of line drawings of real-world objects and nonsense shapes and captures some of the processes important in judgments of subjective complexity, while removing the bias due to familiarity effects.     

Scham und Berührung

The problem

Are there correlations between shame and touch in healthy persons?

Methods

Data from a questionnaire survey with the Skin Satisfaction Questionnaire (HautZuf) with 140 healthy persons were validated with TAS 26, HADS and the Adult Attachment Scale.

Results

There are significant correlations in the scale shame with all other scales of the used questionnaires TAS-26, AAS and HADS. There was a negative correlation between the scale ?physical closeness“ and ?confidence“ of the AAS, but all other scales correlated positively with the shame scale.

Conclusions

More emotions of shame seem to be present with anxiety, depression and disturbances in the sense of an alexithymia concept. Also high feelings of shame correlated with decreased confidence in the personal environment and greater intolerance for personal nearness. The significant correlations between shame affects and self-touch or touch by partner point to important factors in self-perception also for the psychotherapeutic context.     

Von anderen Patienten lernen

Today, internet-based technologies are used at all levels of psychosocial services. Current psychotherapeutic applications concentrate on the implementation of traditional approaches in the internet. Self-help programs are posted onto the net, therapies are conducted via e-mail and groups meet in virtual chat rooms. If one looks at the development of the web over the last 2 years, it becomes clear that the substantial growth and popularity of this medium is due to internet platforms where contents and knowledge can be developed in collaborative environments and experiences can be shared with other users. The present paper addresses this development. On the basis of our example it is discussed how collaborative elements can be integrated into a psychotherapeutic application.     

Psychosoziale Versorgungsforschung

Health is of high value. Therefore, an effective and efficient care is a widely accepted societal objective. Correspondingly, health service research in general and for the psychosocial area in particular receives increasing attention from politics, health and pension insurance companies and professional organisations. These stakeholders promote health service research with considerable financial means. The various promotional programs are described and their implications are discussed. The relationship between content, purposes and methodology for the definition of research in health care is clarified. Finally, current research questions are exemplified by five key topics.     

Glaubhaftigkeitsbegutachtung – mehr als Merkmalsorientierte Inhaltsanalyse

The diagnostic value of criteria-based content analyses (CBCA) for assessing statement credibility has been widely acknowledged. However, theoretical considerations and empirical results show that CBCA is basically appropriate for discrimination between fabricated and truthful accounts. CBCA does not differentiate between truthful and suggested statements and can therefore not help to decide upon a suggestion hypothesis. Moreover truthful accounts do not always contain many CBCA criteria. It is argued that CBCA is for these reasons not a method for substantiating a truthful statement, but a method for rejecting a fabrication hypothesis As a whole Statement validity analysis is the process of systematically generating and evaluating hypotheses about potential origins of the given statement. Only in a subgroup of cases CBCA constitutes the major part of this diagnostic procedure.     

Täuschungsstrategien von Kindern, Jugendlichen und Erwachsenen

Criteria-Based Content Analysis (22) is part of the Statement Validity Assessment (SVA), a method used for assessing the credibility of witness’ statements. CBCA relies on two assumptions, one referring to the cognitive strain of inventing a complex false declaration, the other being related to self presentation as a competent, reliable and truthful person by avoiding potentially “damaging” contents. When evalutating statements, forensic experts take into account that cognitive capacity - and thus potential content quality of a false declaration - increases with age. On the other hand there is no empirical evidence for an improvement of deceptive self-presentation strategies so far. Recent studies on content-related deceptive strategies with children and adults support the assumption that children as well as adults do apply specific deception strategies. Due to methodological differences, however, a direct comparison between these studies to obtain results on possible age effects has not been possible. The aim of this study was to investigate whether children, adolescents and adults differ in the content-related deceptive strategies they apply. Children (n = 48), adolescents (n = 73) and adults (n = 50) were given an age appropriate standardized questionnaire about their content-related deception strategies. Results show age differences in the strategic value assigned to certain content characteristics.     

Wurden schizophrene Maßregelpatienten zuvor in der Allgemeinpsychiatrie unzureichend behandelt?

Since 1996 we have had a marked increase in the number of admissions to special psychiatric hospitals for mentally ill offenders in Germany. Still higher was the increase in schizophrenic patients admitted to these facilities. The question arose whether deficits of the psychiatric health system are contributing to these changes. We studied the medical history of 50 schizophrenic patients, each of whom was hopitalized in the Berlin special hospital in the periods of 1985-1988 and 2002-2004. Surprisingly, there was no difference in the duration of former psychiatric hospitalizations and medical treatment. There was also no difference in the number of dubious releases from the general psychiatric hospital. But we found a marked increase of co-morbid drug abuse and of noncompliance to treatment.