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.     

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.     

Das Leugnen der Tat bei der Entscheidung über die Aussetzung der Reststrafe

The article is about the question whether or not a convicted person can be released on probation even though they are denying their offence. According to German Criminal Law, release on probation must be considered (by a special chamber of the court, “Chamber of Execution”; same question for any kind of Parole Board in other countries) in every case as soon as two thirds of the sentence are served, regardless the convicted person does or does not confess their offence. Using a case example, the article will show as to how the convict’s denial becomes a meaningful fact in the decision-making process. Besides referring to certain conclusions about criminal prognosis following from denying – which of course is a main issue with the decision about release, often valued by the help of expert testimony –, the focus will be set on the judicial framework around this question: Does the law give provisions on how to deal with denial, and how does the principle “nemo tenetur” (nobody has to charge themselves, harm their defence, nor give evidence against themselves) impact the considerations?     

The Role of Occupational Characteristics and Occupational Imbalance in Explaining Well-being

One of the key factors for promoting well-being lies in balancing one’s daily life occupations and the nature of these occupations. Occupation refers to a group of everyday life goal-directed activities which may be associated to any life domain, not necessarily work, such as leisure, education, or self-care. Yet it is not clear what constitutes occupational imbalance, and its association to other factors has not been examined systematically. This study proposed and tested a theoretical model for specifying the structural relationships between occupational imbalance, occupational characteristics, personality and well-being. 288 working adults completed the following questionnaires: Inter-goal Relations Questionnaire (occupational imbalance), Personal Projects Analysis (occupational characteristics), the Big Five Inventory (personality traits) and the Satisfaction with Life Scale (well-being). Twenty-five models were tested using structural equation modeling. All the models fit the data well. Occupational characteristics, with the exception of stress, served as significant mediators between personality and well-being, yet occupational imbalance did not play a significant role across all models. Our findings provide substantial support for the importance of occupation to well-being, however occupational imbalance is still an elusive concept that requires further investigation theoretically and empirically.     

Has someone moved my plate? The immediate and persistent effects of object location changes on gaze allocation during natural scene viewing

In this study, we investigated the immediate and persisting effects of object location changes on gaze control during scene viewing. Participants repeatedly inspected a randomized set of naturalistic scenes for later questioning. On the seventh presentation, an object was shown at a new location, whereas the change was reversed for all subsequent presentations of the scene. We tested whether deviations from stored scene representations would modify eye movements to the changed regions and whether these effects would persist. We found that changed objects were looked at longer and more often, regardless of change reportability. These effects were most pronounced immediately after the change occurred and quickly leveled off once a scene remained unchanged. However, participants continued to perform short validation checks to changed scene regions, which implies a persistent modulation of eye movement control beyond the occurrence of object location changes.     

Centrifugal acceleration to 3Gz is related to increased release of stress hormones and decreased mood in men and women

It has been suggested that the central and peripheral neural processes (CPNP) are affected by gravitational changes. Based on the previous experiments during parabolic flights, central and peripheral changes may not only be due to the changed gravitational forces but also due to neuroendocrine reactions related to the psycho-physiological consequences of gravitational changes. The present study focuses on the interaction of neuroendocrine changes and the physical and mental states after acceleration to three-time terrestrial gravity (3Gz). Eleven participants (29.4+/-5.1 [SD] years (male (n=8): 30+/-5.1 years; female (n=3): 27.7+/-2.1 years) underwent a 15 min acceleration to 3Gz in a human centrifuge. Before and after the acceleration to 3Gz circulating stress hormone concentrations (cortisol, adrenocorticotropic hormone (ACTH), prolactin, epinephrine, norepinephrine) and perceived physical and mental states were recorded. A second control group of 11 participants underwent the same testing procedure in a laboratory session. Serum cortisol concentration during exposure to the centrifugal acceleration increased by 70%, plasma concentration of ACTH increased threefold, prolactin twofold, epinephrine by 70% and norepinephrine by 45%, whereas the perceived physical well-being decreased. These findings demonstrate that psycho-physiological changes have to be regarded as a relevant factor for the changes in CPNP during phases of hypergravity exposure.     

Substance Use and Health and Safety among Homeless Youth

This study examines how substance use is associated with the health and safety of homeless youth using cross-sectional, self-report data from 285 homeless adolescents. Path models were used to examine concurrent relationships between youth’s substance use and multiple aspects of their health and safety, including measures of psychological distress, housing risk and instability, and medical problems. Substance use was examined with both global (i.e., a composite of days of use across various drugs and alcohol) and specific (i.e., rates of use of specific drugs, injection drug use) measures. After controlling for demographic and historical variables, number of days of use was significantly related to psychological distress, whereas injection drug use was significantly related to housing risk. Examination of specific drugs revealed relationships between psychological distress and the use of alcohol, cocaine, and amphetamines, and a specific relationship between housing risk and the use of heroin. None of the measures of substance use was significantly related to youth’s medical problems. Implications for interventions with homeless adolescents are discussed.