Evidenzbasierte Psychotherapie der Depression

Depressive disorders are among the most frequent reasons for utilizing the health care system. Despite the availability of efficacious treatments and further advances throughout the last years, there is still a need for improving diagnostic and therapeutic procedures. A promising approach is the implementation of evidence- and consensus-based guidelines. The German “Nationale VersorgungsLeitlinie Unipolare Depression” are evidence- and consensus-based clinical practise guidelines for patients with unipolar depression. All relevant stakeholders have been involved in its development and have passed the final version at the end of 2009 to foster compliance throughout. The available evidence allows the derivation of differentiated treatment recommendations, also with regard to concomitant antidepressant medication or as alternative treatment options. In acute therapy watchful waiting over 14 days is recommended for mild depression and psychotherapy after persistence of symptoms. In cases of moderate depression, psychotherapy and pharmacotherapy are equally recommended, in cases of severe depression a combination of both is recommended.     

Psychische Faktoren gastrointestinaler Erkrankungen

The list of potential or proven associations between psychological and intestinal functions in healthy subjects and in patients with functional and organic bowel disorders demonstrates that although these associations are manifold they are to a large extent incompletely understood, primarily of academic interest and not yet ready to be integrated into everyday clinical practice. However, of immediate practical relevance are psychotherapeutic as well as psychopharmacological approaches. It is, however, required that clinicians, both medical and psychological, are aware of the mechanisms of regulation of intestinal functions through central (CNS) and peripheral (ENS) neural circuits.     

Berufliche Leistungsfähigkeit

In different fields of law the assessment of capability of performance is important and often poses a particular challenge for medical or psychological experts. The present article introduces a model for the assessment of capability of performance developed on the background of a multicenter and interdisciplinary research project. This approach of assessment assumes that the performance capability of a person with psychiatric or psychosomatic disorders does not arise from symptomatology alone; instead, it is also a consequence of interactions between coping processes of the individual and environmental factors. The presented model of the assessment of performance capability is mainly oriented to the “International Classification of Functioning” (ICF; WHO) whose central diagnostic categories are, in addition to the disorder and the somatic and psychiatric functions, the levels of activity and participation. The different assessing levels are operationalized in the assessment model. In this article the various diagnostic levels and their interactions and the criteria which have been formulated are described. The process of decision-making is explored as well. This assessment model aims to make a more reliable, valid and transparent process of expert decision-making in order to increase the objectivity and justice of the assessment procedure.     

Begutachtung von Traumatisierungen

The assessment of trauma related-disorders belongs to the most controversial and medically as well as juridically most broadly discussed fields. Accordingly, the juridical basis and clinical implications are presented and discussed. In doing so, among other things the principles of the causality judgement, the damage-related factors and those damage-independent factors which have to be considered are described. They are discussed in the context of social-juridical and insurance-juridical contexts. Some specific features of the clinical investigation situation are shown.     

Management der Parkinson-Demenz und Demenz mit Lewy-Körperchen

Idiopathisches Parkinson-Syndrom mit Demenz (PDD) und Demenz mit Lewy-K?rperchen (DLB) sind partiell unterschiedliche Manifestationen des Spektrums der Lewy-K?rperchen- und Alzheimer-Erkrankungen. Die Kombination von motorischer Parkinsonsymptomatik mit Demenz, affektiven St?rungen (Depression, Angst), Verhaltensst?rungen (wie REM-Sleep Behaviour Disorder) und psychotischen Episoden (Halluzinationen, Wahn, Delir) neben einer Reihe vegetativer Symptome und zunehmendem Nebenwirkungsrisiko erfordern eine ma?geschneiderte, sorgf?ltige, kombinierte Pharmakotherapie (L-Dopa mit Decarboxylasehemmer, gegebenenfalls Entacapone oder Tolcapone, neuere Antidepressiva wie SSRI, NaSSA, SNRI, Clozapin, Clonazepam, Therapie vegetativer St?rungen) und engmaschige klinische Kontrollen.     

Leugnen der Tat und Tatbearbeitung in der prognostischen Begutachtung

The perpetrator’s examination of his own criminal actions seems to be very important for the risk assessment by the German criminal justice and psychological and psychiatric experts. At the same time other risk factors like general dissociality, the structure of the future neighbourhood, the patterns of social bindings, and personal core competencies seem to be more important for the prevention of criminal recidivism. Anyway the analysis of one’s own criminal offence may enlighten the individual attitudes and behavioral problems and thus may become an important domain of cognitive restructuring. If a convict still denies his deed this not necessarily makes a parole impossible. Denial may indicate a general hostility against the law, but in other cases it is caused by overwhelming shame and indicates positive bindings to social norms.     

Aktuelle Aspekte des Gefängnissuizids

Suicides present a major complication during imprisonment and contribute essentially to the high mortality rate of prisoners. All international studies found increased suicide rates among prisoners in comparison to the general population. This article reviews general and individual risk factors for suicide in prison and possible contributing specific stress factors during imprisonment. The main results of the analysis of the European Annual Prison Statistics from 1997 to 2007 are presented referring to macrostructural determining risk factors for suicide in prison. Measurements and prevention strategies are briefly discussed.     

Zusammenhang zwischen Art der strafbaren Handlung und Suizid in Haftanstalten der USA

Does the nature of the criminal charge or conviction influence whether a jail or prison inmate will take his life? In the United States several nationwide surveys provide relevant information for answering this question. Studies of jail suicides in 1979, 1985 and 1986 respectively indicated that most inmates who committed suicide were charged with nonviolent offenses including drug related or minor offenses. In more recent national surveys the rate of suicide among jail inmates charged with violent offenses was triple that for those charged with nonviolent offenses. Offenses with the highest rates of suicide were kidnapping, rape and homicide. In prisons, where the rate of suicide is much lower than in jails, the rate of suicide for violent prisoners was twice that for nonviolent prisoners. Violent offenses with the highest rates of suicide in prisons included kidnapping, homicide, sexual assault and assault. Discussion addresses the discrepant results between the early surveys of jail suicides and the more recent surveys of suicides in jails and prisons. Further explored are possible explanations for the earlier predominance of nonviolent offenses among suicide victims, the recently elevated rates among violent offenses, and the elevated rates among specific criminal offenses. Commentary is also given to the practical implications of these findings.