Ambulante Psychotherapie der Substanzstörungen

Background

The revision of the psychotherapy guidelines in 2011 broadened the options for treating substance use disorders (SUD) in outpatient psychotherapy (OP).

Aim

The aims of this study were to answer the following questions: how frequently are SUDs treated in OP? What opinions do psychotherapists (PT) hold concerning the new treatment possibilities?

Material and methods

In this study the frequency of OP for patients with SUD, e.g. harmful use and abuse of as well as dependence on psychotropic substances according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10), by private practice PTs as well as their attitude towards the treatment of patients with these diagnoses were investigated. Private practice PTs in five states in East Germany were asked to participate in a postal survey.

Results

Of the 1,382 PTs contacted, 229 (16.6 %) participated in the study. Of the respondents 94.3 % had treated at least one patient with SUD (4-week prevalence including nicotine dependence). These rates ranged from 3.1 % to 26.6 % depending on the substance and diagnosis (SUD as primary reason for treatment). The highest rates of strong affirmation for OP of approximately 20?% were found for disorders related to alcohol, tobacco and medication.

Conclusion

Most PTs treated at least one patient with SUD in OP. However, this particular type of treatment offer should be further extended. Information about the options of treating SUD in OP should be further disseminated and conducting such treatment should be supported by (e.g.) therapist training.     

Qualifizierung und Qualitätskontrolle in der forensischen Psychiatrie – die aktuelle Situation in der Schweiz

The practice of civil expert opinions in Switzerland is in a period of upheaval due to fundamental alterations regarding the legal foundations which were implemented on 1 January 2013. The new civil code displaces the authority to order measures which restrict people’s liberty based on an endangerment to themselves or third parties from a lay institution to a newly created expert committee. Moreover, patient’s rights are greatly enhanced. The subsequent consequences for expert opinion activities are not yet appraisable. The development in the practice of insurance legal expert opinion is influenced by new legal measures which aim at reducing the growing number of new disability retirements most notably due to psychiatric disorders. In contrast to the civil area there are already clearly defined standards for the insurance legal area which were established by the Swiss Society of Psychiatry and Psychotherapy in 2012. The legal foundations as well as the practice of expert opinions in the context of the Swiss civil and insurance law are comparable with the German situation but there are still some important differences related to the content and terminology. This paper outlines the current situation and recent developments in Switzerland as well as pointing out differences in comparison to Germany.     

HRTEM observation of interfacial dislocations at faceted Al–Pb interfaces

Al–Pb ribbons containing 1?at.%?Pb have been produced by melt-spinning and subsequently investigated by high-resolution transmission electron microscopy. It is shown that the lattice mismatch of about 22% between the nanometre-sized Pb inclusions and the surrounding Al matrix is accommodated by a periodic array of misfit dislocations at the Al–Pb interface. The closing failures of Burgers circuits drawn around misfit dislocations on {111} and {100} facets identify the corresponding Burgers vectors as (a ₀/4)? 211 ? and (a ₀/2)? 110?, respectively. The Burgers vector of (a ₀/4)? 211? corresponds to the projected edge part of a 60° (a ₀/2)? 110? dislocation. The Pb inclusions themselves appear to be free of defects.     

Two-year outcome of internet-based relapse prevention for partially remitted depression

The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95% = 2.5–24.9) and in the control group it was 60.9% (CI 95% = 44.8–77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression.