Psychodynamische Kurzzeittherapie bei dependenter und vermeidender Persönlichkeitsstörung

Although dependent and avoidant personality disorders are frequent in patient populations, there are only few studies in which the efficacy of psychotherapeutic interventions for these two personality disorders was reviewed. The purpose of this study was to examine whether psychodynamic short-term therapy based on the model of the cyclic maladaptive pattern (CMP) is effective for reducing the mental impairment of patients diagnosed with a dependent or an avoidant personality disorder. Data were collected via a self-report scale (Symptom-Checklist, SCL) and expert ratings by therapists [Global Assessment of Functioning (GAF) Scale and Severity of Impairment-Score (Beeinträchtigungsschwere-Score, BSS)]. In the study 20 patients received 25 sessions of outpatient therapy. Mental impairment decreased significantly from the beginning to the end of the therapy; moreover this decrease remained stable over a 2-year period following completion of the therapy. The findings show that psychodynamic short-term therapy can lead to an enduring improvement in the mental health of patients with a dependent or an avoidant personality disorder.     

Die Abschaffung der somatoformen Störungen durch DSM-5 – ein akademischer Schildbürgerstreich?

The new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has introduced “somatic symptom disorder” as a diagnosis which is no longer differentiated into medically unexplained and explained physical symptoms. As a consequence, the status of somatoform disorders as an independent clinical group is called into question. Against all original intentions, the semantic, conceptual and practical problems of the previous classification have not been solved. The validity of the new diagnosis is doubtful because of its over-inclusive character. Further points of criticism are the less than optimal selection of psychological features, the abandonment of hypochondriasis as a homogeneous concept and imprecise workmanship of the diagnostic criteria where exclusion criteria needed for differential diagnosis are missing.     

Direktausbildung Psychotherapie an der medizinischen Fakultät

Background

There is ongoing political discussion at the Federal Ministry of Health that a university entrance diploma should allow psychotherapy to be studied directly: Graduation leads to a licensure that qualifies for further specialization, e.g. in cognitive behavioral therapy (CBT) or psychodynamic psychotherapy analog to medical specialization. As psychotherapy has its roots in both psychology and in medicine, the question is raised which faculty should be the future home of direct psychotherapy schools.

Material and methods

A theoretical model curriculum of psychosomatic psychotherapy is proposed. Its structure which is oriented to the established structure of medical training and its contents are described. It is argued that the proposed model in the tradition of psychosomatic medicine is suitable to meet ongoing changes in the structure of psychotherapeutic care due to new challenges in the field of public health.

Conclusion

The study of psychotherapy should be associated with chairs in clinical psychology and psychosomatic medicine in order to maintain and further develop the variety and quality which psychotherapy has gained in Germany.     

Gekränkte Eitelkeiten

The aim of terror is not (only) damage to individual people but the uncertainty and threat to society that also suffers considerable damage. This secondary damage is usually substantially greater than the primary damage. This objective of terror is not only pursued by extremist organizations and groups but also by lone terrorist fighters. In the last 100 years 4 people were known internationally as lone wolf terrorists in the western hemisphere: the highschool teacher Ernst August Wagner, the American “unabomber” Theodore John Kaczynski, the Austrian letter bomber Franz Fuchs and the Norwegian mass murderer Anders Behring Breivik. Franz Fuchs was examined by the author and the background to his actions can be taken from own professional experience. Information available about the other perpetrators also reveals similarities to the personality traits and developmental steps which seem to have been important for the terrorist actsand include long periods of a lack of social resonance, rejection and mortification, social withdrawal and autistic demarcation and development of a pseudopolitical ideas (of grandiosity). Each of these lone wolf terrorists tried to pursue their ideals through terror, threats and intimidation of the public, and their own importance grew by the wide public attention which was fueled by the insecurity of the public. The interest should not only be directed to those individual lone wolf terrorists of this caliber or to the terrorism of states, organizations and groups or to their structure and dynamics but also to the media and public reactions, and finally to the response of society, as they mutually reinforce actions of the terrorists and help the offenders to achieve their goals.     

Intelligenzgeminderte Rechtsbrecher im Maßregelvollzug

Forensic patients with intellectual disabilities have so far received little attention which is reflected in the comparatively briefly written chapters in the standard textbooks and also the low scientific interest in this patient group. There are only few therapeutic concepts and even less information on their effectiveness. This article presents the Christophorus Clinic in Münster which was the first forensic institution in Germany to specialize in these patients. The institution incorporates 54 treatment places and started operating on 3 June 2011. In addition to the known fact that a therapy concept must (further) develop over the years, during the first year of operation some aspects have arisen which have cristallized as problem areas specific for this patient group, which are discussed.     

Standards nichtstrafrechtlicher psychiatrischer Begutachtung

The introduction of the certificate for forensic psychiatry of the German Association of Psychiatry, Psychotherapy, Psychosomatics (DGPPN) in 2000 was a significant contribution to raising awareness of the formal and substantive requirements for forensic psychiatric evaluations and to develop a systematic quality improvement in forensic psychiatric expert services. By the special dominance of the certification in the field of penal law assessment, this proved to be problematic for many predominantly non-penal experts. This led to a requirement to develop a qualification for the non-penal expert opinions. In particular the increasing specialization of the psychiatric disciplines and the diversity of the legal issues and framework require a continuing education in the field of non-penal psychiatric assessments. Substantive and formal requirements are discussed and a continuous process of quality improvement and assurance is outlined. Last but not least a plea is made for close interdisciplinary exchange with the jurisprudence and the courts in the context of quality circles.     

Beurteilung von Einsichts- und Steuerungsfähigkeit bei Personen mit geistiger Behinderung im Strafverfahren

Reference is made to the content determination of the entry term “mental retardation” in the criminal responsibility paragraphs of the Penal Code. The forensic relevance of intellectual disability is low. Forensic effects of retarded ability for reasoning usually fail due to the understanding in question. A diminution of criminal responsibility can if necessary be justified by a reduction in accountability.