Psychosomatische Rehabilitation

Besides inpatient and outpatient treatment, rehabilitation represents the third column of the German healthcare system. The goal for the persons concerned is the conservation of activity and participation in the professional and social life. This article shows the importance and development of German psychosomatic rehabilitation in contrast to regular inpatient treatment. It also explains its place in the whole healthcare concept of rehabilitation and the basic principles of sociomedical assessment, followed by practical advice for the indications and the rehabilitation application process. Compared with other countries Germany has a very well-established system of psychosomatic rehabilitation but this resource is often used too late in the course of treatment, mostly not until severe chronification has occurred and in addition there are also problems with points of interaction concerning the subsequent outpatient treatment. The aim of this article is therefore to contribute to an improved cross-linking of the different areas in the healthcare system.     

Nichtspezifische,funktionelle und somatoforme Körperbeschwerden

In the S3 guidelines on non-specific, functional and somatoform bodily complaints, a broad group of medical and psychological societies as well as patient representatives have for the first time achieved an evidence-based consensus on terminology and care of these patients. This paper summarizes the main background information and recommendations for psychotherapists. For mild courses treatment by the general practitioner with establishment of a biopsychosocial explanatory model and physical as well as social activation is usually sufficient. More severe courses call for cooperative, coordinated management, including regular appointments with the general practitioner, graded activation and psychotherapy, especially cognitive behavioral, in addition to psychodynamic interpersonal or hypnotherapeutic imaginative psychotherapy. In particularly severe courses multimodal and if necessary day clinic or inpatient treatment is needed. Additionally the patient guidelines for affected people and their relatives are presented.     

„Schicksalsklüfte“

The present paper deals with the derivation of the fate concept and its application in psychotherapeutic theory and practice. Conclusions for an extension of the practical therapeutic view on existential themes, such as meaning, freedom, loneliness and death are drawn and effects on the therapeutic relationship are presented.     

Secondos

“Secondo” is a Swiss term for a person of the second generation after migration. While migrant children of the first generation carry high psychosocial risks, the rate of behavioral or emotional disorders is only slightly higher in children of the second generation. Early childhood raising practices and socialization can differ greatly from one country to the next which have to be considered in psychotherapy. Specific child raising practices and the effects are exemplified for India. Two case reports of a boy with a major depression and a girl with a combined depressive and anxiety disorder illustrate the relevance of an Asian cultural background in the second generation. Both children were treated with sandplay therapy.     

Lifeline in der Narrativen Expositionstherapie

The biographical memory of patients with trauma spectrum disorders is often shattered. Survivors cannot voluntarily access memories. Sometimes in survivors of severe and complex trauma whole life periods seem lost, avoidance sets in, the autobiography is sketchy, seems strange and ego-alien. The lifeline tool in Narrative Exposure Therapy (NET) is an effective first step towards discussing the traumatic material. The lifeline in NET displays the emotional highlights of the person’s life in a symbolic way. Looking at one’s autobiography from an allocentric perspective can serve as a controlled contact to the fragmented memories. This is then followed by a well-directed imaginal exposure from which a chronological narrative emerges. Laying out the lifeline at the end of the NET treatment enables the person to perceive the gestalt of the course of life.     

Worte wägen

Interventions relating to cognition without the intention of interpretation occur in classical psychodynamic therapy; however, the application is less elaborated than in cognitive behavior therapy. It can often also be observed that “dysfunctional” cognition is accepted over a long time by psychodynamic therapists without any reflection. This article discusses specific work on this topic and the use of functional cognition and this is recommended for structurally disturbed and traumatized patients.     

论疾病治疗的自然观

人体本身对各类疾病有着强大的自我抵制和修复能力,疾病的发生和康复有其自然的进展规律,治疗疾病的过程应遵循相关规律,并辅助人体的这些能力去促进机体的修复。而现实医疗中,人们在享受医学科技成果和医疗保障实惠的同时,常常伴有过度的医疗处置或过度忽视疾病的存在,从而影响疾病本身的自然康复进程,或加重病情,甚至造成二次伤害。本文从疾病治疗自然观的角度探讨了医生和患者在应对疾病时需了解的辩证思想,并就如何认识和应用疾病治疗的自然观去诊治疾病做一探讨。     

Self‐construal and students’ math self‐concept,anxiety and achievement: An examination of achievement goals as mediators

This study examines the role of self‐construal in student learning by testing a mediation model: through math achievement goals, self‐construal predicts math self‐concept and anxiety, which further predict math achievement. A sample of 1196 students from 104 secondary classes in Singapore took a survey and a math achievement test. The results from multi‐group structural equation modelling support measurement invariance and equal path coefficients in the mediation model between boys and girls. Interdependent self‐construal positively predicted mastery approach and avoidance goals, through which interdependent self‐construal had a positive total indirect effect on math anxiety. Independent self‐construal positively predicted mastery approach, performance approach and performance avoidance goals, and through the two approach goals, high independent self‐construal was associated with high math self‐concept. Overall, self‐construal was not associated with math achievement. The findings enhance our understanding of achievement motivation from a sociocultural perspective and help explain East Asian students’ relatively higher anxiety and lower self‐concept in comparison with their Western counterparts as reported in international studies.     

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.