Autoimmun-Enzephalitiden – eine Erkrankungsgruppe mit vielen Gesichtern

During the last 10 years a number of syndromes with antibodies against neuronal surface antigens have been characterized. Adults as well as children can be affected. Patients may suffer from amnestic syndrome, other cognitive deficits, seizures, or psychiatric symptoms. Some patients develop generalized encephalopathy with altered levels of consciousness, hyperkinesias, and hypothalamic disorders. In some patients, ovarial teratoma, thymoma, or small cell lung cancer can be diagnosed. However, in most patients no tumor is found. These syndromes were previously called autoimmune channelopathies. In fact, most antigens are not part of an ion channel but proteins or part of protein complexes on the cell surface of neurons, axons, dendrites, or synaptic terminals. These proteins are expressed throughout the nervous system. Interestingly, in limbic encephalitis very circumscribed brain regions are affected. This may be due to an increased vulnerability or accessibility of the affected brain regions. Limbic encephalitis is a well-characterized form of autoimmune encephalitis, which can be associated with different antibodies. Anti-NMDA-receptor encephalitis is not restricted to the limbic system. Characterization of other syndromes and auto-antibodies are expected in the future. In this review, aspects of limbic encephalitis and anti-NMDA-receptor encephalitis will be discussed.     

Die Hysterie im neuen Gewand und im Wandel der Zeit

Classical symptoms of hysteria – especially symptoms of hysterical neurosis (conversion type) – are not commonly seen any more. On the one hand, general knowledge about the function of hysterical has led to suppression of the underlying hidden conflicts, possibly up to resomatization. On the other hand, those affected may have rather subtle symptoms, e.g., vague pain, circulatory disorders, or fatigue. Overall, the hysterical phenomena have not become less common but have become “contemporary” and, therefore, more difficult to identify. Reliable epidemiological data, however, are difficult to obtain. Rough estimates indicate that 2–6?% of all people have dissociative disorders (ICD-10 definition). Histrionic personality disorder is estimated to occur with a frequency of 2–3?%. In 75?% of cases, the disease manifests relatively early, between the ages of 17 and 32 years and with a 3:1 female to male ratio. An average of 7 years elapses between first manifestation and the start of psychiatric–psychotherapeutic treatment.     

Lumbale Radikulopathie

Back pain is a common pain syndrome in the general population. The most common cause is lumbar disc disease and only rarely bony degenerative changes of the spine. Other causes of lumbar radiculopathy include local lesions. Inflammatory changes or meningeal carcinomatosis may also lead to lumbar nerve root damage. With pronounced clinical symptoms, motor deficits of the associated muscles can occur, including weakening of muscle reflexes. In addition to thorough education of the patient about the origin, likely duration, and treatment of the disease, a combination of physical therapy and pharmacotherapy is the basis for successful treatment of lumbar radiculopathy. In cases of severe paralysis, bladder and rectal paralysis, and corresponding compression of nerves, urgent spinal surgery is inevitable.     

Eine erfolgreiche Behandlunsgkette bei Zwangsstörung

Obsessive-compulsive disorder (OCD) belongs to a group of disorders with an estimated lifetime prevalence of 2?%, associated with a high socio-economic burden and the risk of chronification. In the latest version of the DSM-5, OCDs were detached from the chapter of anxiety disorders, similar to the ICD-10. Consequently, the fifth revision of the DSM highlights the fact that scientific results so far, like the overactivation of basal-ganglia thalamocortical circuits, basically support a common model for OCDs. Although in the past, OCDs have been ignored as a diagnostic entity, in the DSM-5, the concept of obsessive–compulsive spectrum disorders according to Hollander was partly realized. The present case report outlines an example of a successful therapeutic chain in the treatment of a severe case of OCD with a 90?% reduction of symptoms throughout a calendar-year, emphazising the importance of efficient treatment chains within psychiatric disorders.     

Das psychische Erbe der Menschheit

The historical development and importance in theory and practice of the term archetype, the core concept of Analytical Psychology, is extensively presented. Beginning with C.G. Jung’s definition of archetype through to the current state of the discussion, various conceptualizations of biological, developmental psychological and cultural theoretical basis are presented. The results show that there is empirical evidence for psychological archetypes, for instance in the neurosciences, developmental psychological and anthropological research and that the classical conception of inheritance of complex symbolic patterns cannot be substantiated by more recent results in human genetics and particularly in epigenetics. The prominent attempts at solving this problem from the contempory Analytical Psychology will be discussed, in particular emergence and system theoretical argumentation. Finally, various empirical, partially experimental studies from Analytical Psychology, among others from the authors themselves, will be presented which confirm the hypothesis of the existence of archetypes and of a collective (unconscious) memory. The article gives a total overview of the state of specialist discussions on the archetype concept for the readership above and beyond the narrow field of Analytical Psychology.     

The Paradox of Holding and Recognizing and the Local Moving Along of the Therapeutic Process

In an attempt to provide a first incomplete answer to the question raised by the editors as to “what cures traumatized patients,” I join my voice to that of the many authors who associate therapeutic action with the process of affect regulation that develops within the analytic dyad. I believe that we are yet to find effective ways of describing the therapeutic process so that the fundamental elements can be reflected upon and studied by therapists. This is especially important when we are working with severely traumatized patients. One of the challenges we are facing today has to do with the way in which therapists communicate such experiences to each other. In our reflections, it all depends on the level at which we situate ourselves, if the therapist places himself/herself at the local level of the interactive process he/she needs to learn to stand in the uncertainty of the security and change paradox relying on the intersubjective process itself. With traumatized patients the challenge in psychotherapy almost always involves the ‘treatment that hurts’ paradox.     

„Rocken statt Ritzen“

Background

Non-suicidal self-injury (NSSI) starts in adolescence and decreases during young adulthood. Despite a high prevalence among adolescents only a few therapeutic interventions directly addressing adolescents exist.

Aim

By connecting music therapy with elements from behavioral therapy an attempt was made to create a therapeutic program which is attractive to adolescents.

Material and methods

A pilot trial of the program “Stop cutting - rock!” was conducted with 12 adolescent females with a mean age of 15.15 years (standard deviation SD ±1.34). The study aimed to compare the frequency of NSSI throughout the treatment phase as well as a pre-post comparison of depression scores.

Results

The results showed a trend towards a decreasing frequency of NSSI. Depression scores decreased significantly between the assessment before therapy and at a 3-month follow-up after the end of the therapy.

Conclusion

The positive feedback concerning music therapeutic elements points to the attractiveness of the approach. By integrating multimodal therapeutic strategies it seems possible to create an individually tailored intervention for adolescents with NSSI.