Teilstationäre Psychotherapie

Psychotherapeutic day clinics increasingly take over responsibility for the treatment of patients who cannot be cared for satisfactorily, respectively, at all in an inpatient setting. Psychotherapy in a day clinic setting is a treatment in its own right which has progressively established itself between inpatient and outpatient treatment. Empirically raised up to date data prove the efficacy and the efficiency of psychotherapeutic treatment in day clinics. Accordingly, the goal of the present study is to investigate the outcomes of psychotherapeutic treatment in a day clinic with a psychodynamic concept. Since 1996 the psychotherapeutic day clinic Basel empirically assesses the treatment course of all admitted patients. Patients and therapists fill in questionnaires upon admittance, two months into the course of treatment and upon discharge (SCL-90-R, PSKB-Se-R, OPD etc.) Our results indicate that significant improvements of symptoms as well as of socio-communicative competency can be achieved during treatment which remain stable even after discharge (first follow-up three months after discharge). Comparing outcome data of patients treated in full-time inpatient setting and of patients who undergo partial hospitalization we found that outcome was at least equivalent. Additionally we found that the diagnosis of a personality disorder influenced treatment results significantly in some symptom specific spheres.     

Therapiewechsler

At least 30% of the patients, currently in psychotherapy, have been in one or more psychotherapeutic treatments before the beginnig of the actual treatment. A great number of these patients decided as a consequence of their experiences with the former therapeutic treatments to change not only the therapist but also the form of the psychotherapy. The task was to find out the reasons for this. 25 patients who had changed from one of the Guideline Therapies into a client-centred therapy (CCT) were interviewed about their reasons for this change. It was assumed, that the failing of earlier therapies was caused by a lack of matching between patient and therapist, treatment and disorder in the sense of the Generic Model of Psychotherapy (GMP) conceptualized by Orlinsky and Howard. The results support this hypotheses: For most of these patients CCT turned out to be a necessary and successful alternative to the previous treatments. Most of the patients reported that they responded better to the therapeutic offer of CCT. The reasons mentioned for choosing another form of psychotherapy support the necessity of a differential indication for psychotherapy on the basis of the GMP.     

Zur Bedeutung des Wahns für die Beurteilung der Schuldfähigkeit nach den §§ 20 und 21 StGB

For the assessment of criminal responsibility of offenders with symptoms of delusion it first has to be examined if one of the four basic elements of §§ 20, 21 of the German Penal Code is fulfilled. For this purpose a careful diagnosis of the type and intensity of the delusion and the underlying psychiatric disease is necessary. If a basic element is fulfilled the effect of the delusion on the ability of the offender to perceive the wrongful character of the act and to control behavior have to be discussed. For this the model of the anthropological cross developed by Winfried Brugger can be helpful.     

Sándor Ferenczi und der Institutionskonflikt der Psychoanalyse

By the foundation of the International Psychoanalytical Association by Freud, Jung and Ferenczi the “psychoanalytic movement” joined into regulated tracks. Thus, the project “Psychoanalysis”, a project in the spirit of the “Aufklärung”, which had prescribed itself to individualistic autonomy, got into breach. In this contribution the reasons are reflected in regard to the establishment as non-university science and the threat of marginalization. They objected Freud’s pretension of influence and belonging. It is unclear why it was explicitly Sándor Ferenczi who was designated to be the precursor of that foundation. He was initially a critical opponent of Freud’s thoughts. His biography illustrates that the institutionalization of psychoanalysis happened too early and that this brought scientific isolation and personal distress over his life when, at the end of his life, he strived for emanzipation in his relationship to Freud.     

Cross-national comparisons of complex problem-solving strategies in two microworlds

Research in the fields of complex problem solving (CPS) and dynamic decision making using microworlds has been mainly conducted in Western industrialized countries. This study analyzes the CPS process by investigating thinking-aloud protocols in five countries. Participants were 511 students from Brazil, Germany, India, the Philippines, and the United States who worked on two microworlds. On the basis of cultural-psychological theories, specific cross-national differences in CPS strategies were hypothesized. Following theories of situatedness of cognition, hypotheses about the specific frequency of problem-solving strategies in the two microworlds were developed. Results of the verbal protocols showed (a) modification of the theoretical CPS model, (b) task dependence of CPS strategies, and (c) cross-national differences in CPS strategies. Participants' CPS processes were particularly influenced by country-specific problem-solving strategies.     

Trait BIS predicts alpha asymmetry and P300 in a Go/No‐Go task

Inspired by the revised Behavioural Inhibition System (BIS) theory the present study probed the association between individual differences in Trait BIS and electroencephalogram indicators of conflict processing/inhibition. Sixty‐nine male participants either high or low in Trait BIS completed a Go/No‐Go task while the electroencephalogram was recorded. As expected, Trait BIS was associated with the No‐Go‐anteriorisation of the P300 event‐related potential (i.e. an index of response inhibition presumably generated in the dorsal anterior cingulate—an area implicated in conflict processing) and with No‐ Go‐related changes towards left frontal alpha activity (i.e. presumably more activity in right prefrontal cortex—an area implicated in response inhibition). These findings support the role of conflict processing attributed to BIS functioning in the revised theory. Copyright © 2009 John Wiley & Sons, Ltd.     

Psychische Störungen bei HIV-Infektion und Aids

The human immunodeficiency virus (HIV) is the pathogen responsible for acquired immune deficiency syndrome (AIDS). Worldwide there are currently about 40 million people infected with HIV and an estimated 44,000 in Germany. If left untreated after a few years the infection leads to the manifestation of AIDS and eventually to death through opportunistic infections and malignant tumors. Infection with HIV is not curable. Nevertheless, antiretroviral treatment can slow the progress of the disease and prolong life expectancy significantly. Once antiretroviral treatment has started the medication must be taken regularly and lifelong. Serious side effects of the medication pose a significant stress on physical and psychological well-being and impair adherence. Infection with HIV means a total change in life perspectives and requires extensive adaptations in lifestyle. Problems with adaptation and mental disorders (e.g. depression, anxiety disorders, adjustment disorder) are, therefore, frequent. With disease progression neurocognitive impairments are increasingly likely. Mental disorders and neurocognitive impairments adversely affect treatment adherence, increase health risk behavior and reduce immune function. Psychological interventions contribute significantly to the reduction in health risk behavior, improve treatment adherence and are successful in the treatment of depression and anxiety.