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.     

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.     

Coconstructing Mother–Infant Distress: The Microsynchrony of Maternal Impingement and Infant Avoidance in the Face-to-Face Encounter

This article takes a new look at the self-experience of creative artists. A five-step model of the creative process is put forth: preparation, inspiration, realization, completion, and objectification. The vicissitudes the creative self undergoes in each step are described, as well as the selfobject experiences needed to sustain the self through each phase. Of particular interest in this regard are the roles of the “muse” and of the artistic community. The article then describes three pathologies that the creative self is particularly prone to: addictions, vertical splits, and depression/isolation. The article concludes with a case example of a female patient who brought her paintings and stories into therapy.     

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.     

Intelligenzgeminderte Rechtsbrecher im Maßregelvollzug

Forensic patients with intellectual disabilities have so far received little attention which is reflected in the comparatively briefly written chapters in the standard textbooks and also the low scientific interest in this patient group. There are only few therapeutic concepts and even less information on their effectiveness. This article presents the Christophorus Clinic in Münster which was the first forensic institution in Germany to specialize in these patients. The institution incorporates 54 treatment places and started operating on 3 June 2011. In addition to the known fact that a therapy concept must (further) develop over the years, during the first year of operation some aspects have arisen which have cristallized as problem areas specific for this patient group, which are discussed.