Traumafolgestörungen bei Erwachsenen, Kindern und Jugendlichen

Valid diagnostics are an essential foundation of a successful psychotherapeutic treatment. For posttraumatic stress disorders this is not always the case, i.e. when questionnaires are applied that do not completely comply with the criteria of a posttraumatic stress disorder according to the classification systems DSM-IV and ICD-10. In the present review, trauma questionnaires frequently applied in German-speaking areas for adults, children and adolescents are presented with their specificities and are critically discussed. Finally, recommendations for diagnosing posttraumatic stress disorders by means of questionnaires are made.     

Epidemiologie psychischer Störungen

The discipline of epidemiology not only contributes to knowledge regarding the distribution and prevalence of mental disorders but also to a better understanding of their causes and consequences. This article focuses on the prevalence and disease burden. Epidemiological studies show that mental disorders are more common than previously thought and that they are associated with a particularly high societal burden. Costs of illness are higher in mental disorders compared to many widespread somatic conditions because of their high prevalence, chronic course, young age of first onset and the profile of disability. The extent of inability to work due to mental disorders is rising steadily although a general decline in absenteeism has been observed across other disease types. This raises the question of whether mental disorders have increased recently. Furthermore, the general need for treatment is discussed as well as the corresponding mental health care options. Finally, it has been found that, despite the quantitatively relatively well-developed health care system in Germany, there are still signs of a significant undertreatment in the field of psychotherapy.     

Die Kriminalprognose bei persönlichkeitsgestörten Straftätern

Many studies have shown that there is an elevated prevalence of personality disorders in criminal offenders in addition to the statistically higher probability of becoming repeat offenders. This article highlights the method of Applied Criminology which explains how this method can help to detect the relevance of personality disorders when applied to an individual case. In a second part of this article the personality disorders are examined and also how this method facilitates the risk assessment process by allowing case managers to highlight the aspects that are prevalent to predict future criminal behavior.     

Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

Objective

There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression.

Method

Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion.

Results

Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers.

Conclusions

The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.

ClinicalTrials.gov registry number

NCT00218959.     

Implications of Independent Versus Interdependent Self-knowledge for Motivated Social Cognition: The Semantic Procedural Interface Model of the Self

The Semantic Procedural Interface Model of the Self (SPI) suggests that, depending on the strength of the situational accessibility of independent or interdependent self-knowledge, people will tend to process stimuli either unaffected by context (context-independency) or cognizant of context (context-dependency). In this paper we describe the cognitive processes underlying context-independent or context-dependent information processing. We suggest that degree of context-dependency depends on cognitive control processes (attentional focus on focal or task-relevant information; inhibition of contextual or task-irrelevant information; task-management). Second, we predict motivational effects of the self's independence/interdependence by including assumptions about possible selves.     

Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale – Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs.     

Fractal Structure of Event Segmentation: Lessons From Reel and Real Events

We investigated fractality in the segmentation of cinematic and live events. Four movies from distinct genres were first analyzed and found to be fractal, albeit in different regions of the fractal range. In Experiment 1, viewers parsed the films' events, attending to short or long timescales, using a button box to indicate break points. The temporal structure of film viewing was found to be fractal regardless of the scale of attention and to reflect the differing fractal editing structure of the films. Experiment 2 found event segmentation to be fractal in a natural setting, a basketball game, as well. An additional parallel between reel and real events was uncovered: fractal indices were at the higher end of the range for both the film genre intended to be anxiogenic and the more suspenseful portion of the basketball game. We argue that the fractal structure of perception reflects the fractal structure of events whether the events are in film or in nature. We speculate that fractal structure has implications for understanding subjective experience and, ultimately, the correspondence between films and the world.     

Self-representing dreams

SUMMARY

Certain dreams are particularly striking for the way they represent themselves and the manner in which they are told within a psychotherapeutic relationship. Within such a dream is contained a picture of the dream's function and significance as part of the transaction between patient and psychotherapist. This phenomenon illustrates the nature and function of unconscious phantasy, the relations that hold between phantasy and mechanisms of defence, and the manifestations of phantasy within the transference.

Three examples are given of self-representing dreams which have been reported and re-enacted by trainee psychiatrists in psychotherapy supervision.     

Loss and change in primary care: Working with organisational anxiety

This paper will consider the identity of an inner voice that is experienced by everyone, but in very different ways. However, when working in the transference with psychotic patients the boundaries of personal identity and the question of choice and volition are so compromised by the illness that the phenomena are so to speak ‘writ large’. This allows the issues to be brought out with great vividness and intensity and it is the struggle with this that has led me to reconsider the identity of the inner voice in a way which I have found useful for the rest of my clinical work.

Prior to 1985, my clinical work with patients with psychotic illnesses was undertaken in the in-patient psychotherapy ward at Shenley Hospital that I was responsible for. With the movement of psychotherapy resources out of Shenley to set up the Willesden Centre, our ability to continue with this work was very compromised because the Centre is entirely an out-patient resource. However, a number of us persevered and gradually worked out ways to be able to continue to offer treatment to patients who had psychotic illnesses. This involved the establishment of a case-manager system to enable the therapist to work in the transference. This evolution has occurred in a specialist workshop that I have been running at the Willesden Centre since 1986.