Psychoonkologie

Changes in the spectrum of illnesses have led to a predominance of chronic diseases, including oncological disorders, that are connected with substantial mental health problems. The needs of people with cancer are increasingly attracting the attention of psychosocial and psychosomatic disciplines as far as patient-oriented health care research and counselling practice are concerned. Psychosocial work in oncology appears to be becoming increasingly professionalized. Theories of the psychosocial origin of cancer are gradually losing ground in the scientific community, giving way to a rational attitude towards oncological diseases that counters the stigma of cancer. At the same time, the demand for psycho-oncological services is becoming more important if we take into account the high rate of psychiatric co-morbidity and the fact that these patients are poorly diagnosed and inadequately treated. This is all the more regrettable in that a broad range of evidence-based interventions are available which are gradually being implemented in the guidelines of rehabilitation facilities and oncological centres of excellence. The transfer of knowledge in the everyday care of cancer patients, however, has yet not been accomplished.     

Sexualdelinquenz bei Schizophrenie

Studies suggest a complex relationship between schizophrenia and sexually offensive behaviour. This study aimed to preserve first findings of sex offence features and behaviours exhibited by psychotic men in Germany. Furthermore a typology of the schizophrenic offender group was developed. A comparative trial design was used to differentiate the psychotic and non psychotic offender group. A checklist was developed and applied to the records of 64 male restricted hospital order in-patients in Berlin with an index conviction for a contact sex offence against a woman. Social isolation, antisocial behaviour, psychosexual variables and adverse childhood experiences are found for schizophrenic and sexual offenders in general. Different sexual offensive behaviours appeared in the schizophrenic subgroups. Negative symptoms of schizophrenia as well as antisocial traits had a great impact on schizophrenic sexual offending. A heterogeneous group of psychotic offenders can be supposed.     

Debiasing the hindsight bias: The role of accessibility experiences and (mis)attributions

Two studies tested the role of accessibility experiences and attributions in debiasing the hindsight bias. Participants listed 4 or 12 thoughts about how a college football game, or the 2000 US Presidential election, might have turned out differently. Listing 12 thoughts was experienced as difficult, suggesting to participants that there were few ways in which the event could have turned out otherwise. Hindsight biases increased under this condition, unless participants attributed the difficulty of the thought generation to their own lack of knowledge, which resulted in a trend in the opposite direction. The interplay of accessible content, accessibility experiences and attribution in mental simulation is discussed.     

Behavioral phenotyping of a murine model of Alzheimer’s disease in a seminaturalistic environment using RFID tracking

Neurodegen erative disorders such as Alzheimer’s disease (AD) are increasingly threatening public health. Most animal models of AD consist of transgenic mice that are usually housed singly or in unisexual groups in small barren cages. Such restricted environments, however, prevent the mice from showing a variety of speciesspecific behaviors and consequently may constrain comprehensive behavioral phenotyping. On the other hand, allowing the animals to freely organize their lives in a spacious physically and socially enriched environment makes behavioral phenotyping laborious and time consuming. Radio frequency identification (RFID) using a network of antennae and small glass-coated transponders labeling each individual allows for gathering spatiotemporal information about a large number of individuals in parallel. The aim of this project was to use the RFID technique to facilitate the characterization of mice carrying a genetic disposition to develop AD-like pathology and of their wild-type conspecifics in a spacious seminaturalistic environment.     

“How many bad apples does it take to spoil the whole barrel?”: Social exclusion and toleration for bad apples

In social dilemmas, where personal welfare is in conflict with collective welfare, there are inherent incentives to act non-cooperatively. Moreover, there is evidence that the example of a few uncooperative group members (“bad apples”) is more influential than the example of comparable numbers of cooperative members (a bad apple effect). Two studies are reported that examine the functional relationship between the number of likely bad apples and individual cooperation, and whether and when the threat of social exclusion for uncooperative behavior may effectively counter the temptation to follow the example of such “bad apples”. It is shown that (a) the threat of exclusion is sufficient to counter the temptation to follow a few bad apples’ example, (b) such threats cannot, however, overcome the cooperation-degrading effects of large numbers (e.g., a majority) of bad apples, and (c) the effectiveness of such threats may be greater in relatively smaller groups.     

Ausbildungs- und Berufserfahrungen älterer Psychoanalytiker

Based on the discussion about the crisis of psychoanalysis and in particular of psychoanalytic training, 145 (female and male) analysts older than 70 years of age were interviewed about their training and professional experiences as well as about their attitudes towards psychoanalysis. This older generation is of great interest because their training generally took place prior to 1967 and preceded the introduction of guideline therapy (cost coverage by the general health insurance) and under much less formalized conditions, which can be seen almost as a contrast to the current circumstances and conditions. This research has shown that especially personal or content and value-based motivations (personal problems, therapeutic experience, interest in the subject, the desire for depth, self-realization and expansion of the situation perceived as restrictive of their former profession) were the main determining factors for the choice of career. The training analyses were, despite some exceptions, of substantial length even then (an average of 544 h), but often had a lower frequency (30% had less than 3 h per week). Since the age limitation for running a psychoanalytic practice within the general health services (formerly 68 years) is no longer compulsory, the results of this study regarding the professional life of older psychoanalysts are of special interest. Of the respondents 45% are still running their own practice and 22% are working as training analysts.     

Forensisch-psychiatrische Versorgungsstrukturen in Deutschland: Ein Vergleich zwischen Alten und Neuen Bundesländern

Differences and similarities of the forensic mental health hospitals in the New Federal States (NFS) (former East Germany) and the Old Federal States (OFS) (former West Germany) were assessed. The focus of the study was set on institutional features of these hospitals as well as on characteristics of the detained patients. Data were based on a survey conducted in 2006. Specifically designed questionnaires were sent to the mental health departments of the State Ministries, and to all forensic mental health hospitals (response rates 100% and 62%). The general finding is that structures of forensic mental health services in NFS and OFS, e.g. the number of beds per million inhabitants and institutional features, have become similar since the German reunification. The health staff-patient relation is equal for some professions, whereas for other professions this relation is even better in NFS. Differences exist regarding the forensic mental health law of the Federal States. Moreover, the proportions of some delicts and diagnoses in the detained clientele differ. In NFS, the need for forensic aftercare facilities is even more urgent than in OFS. In both parts of the country there is a need for the development of some aspects of quality assurance for both forensic mental health hospitals as well as governmental institutions. Generally, the evaluation of quality of structures, processes and results is yet impossible for many fields of forensic mental health care, because there is no sufficient data base.     

Psychiatrischer Beitrag

Ohne Zusammenfassung     

Embracing the other: Revisiting the epistemological foundations of family systems therapy

Family systems therapy originated in the 1960s, 1970s, and 1980s through the work of innovative thinkers and clinicians. However, despite the creative contributions of the mentioned colleagues and of later innovations in family therapy theory and practice, it seems as though the dominant culture of establishment psychiatry in the United States (and in most Western countries) to this day has not seriously incorporated relationships, social context, or community connectedness into the treatment of individuals with psychiatric diagnoses. For the “psychiatric” patients diagnosed according to the DSM-5, the dominant underlying epistemological perspective is the medical “scientific” paradigm. Within this approach there is a dearth of reflections about the truthfulness of so-called “empirical facts” and a lack of skepticism about the techniques of “measurement” of the psychiatric illness. The alternative, relationship-oriented, context-sensitive, and community-connected thinking paradigm is highlighted here in contrast to the “psychiatric” foundation. This paradigm consists of (a) the awareness that all human Subjects (including “psychiatric” clients) are constituted as such by their relational connection to others; (b) the awareness of our sensitivity to and embeddedness in a socio-economic, cultural, and racial context; and (c) the awareness of our involvement in and connectedness with many kinds of communities.