Stress and reproduction: introduction to the special section.

This special section on stress and reproduction is devoted to an emerging frontier in interdisciplinary research that merits the attention of health psychologists. The majority of the studies concern the role of stress and emotion on birth outcomes such as low birth weight, fetal growth and preterm delivery, or mechanisms underlying these findings. The implications of this research extend from maternal and infant health to life-span development and adult health and mortality.     

Topografie der Jugenddelinquenz

The article shows that the registered juvenile delinquency has decreased in recent years. Serious violent crime partially exists, but this is only a small part of the overall juvenile delinquency. Forms of appearance of these violent crimes are outlined. With the help of a dark field study it is illustrated that there is a great variety of delinquency among young people. There are young people showing mostly law-abiding behavior, infrequent offenders and a group with a significant burden of crimes.     

Partizipationsverhalten schizophren erkrankter Patienten in Psychoedukationsgruppen

Background

The effectiveness of psychoeducation groups for people with schizophrenia is well documented; however, there are no studies which examined patient participation behavior although this behavior might be critical for accomplishment of the therapeutic goals. This article presents newly developed 4-point Likert scale, the participation quality rating scale (PQRS), together with initial results on practicability, validity, change sensitivity, sociodemographic and clinical correlates and on the question whether participation quality might be a significant predictor of the short and long-term outcome of psychoeducation.

Patient and methods

Within the framework of the Munich Study “Cognitive Determinants of Psychoeducation and Information in Schizophrenic Psychoses” (COGPIP) the individual participation behavior of 97 patients with schizophrenia was examined after each psychoeducational group session (4 weeks). Individual mean PQRS scores were correlated with sociodemographic, anamnestic and clinical variables. In addition to change sensitivity the ability of the scale to predict the acquisition of illness knowledge during psychoeducation was examined as well as readmission during a 9-month follow-up period and the psychopathological endpoint (positive and negative syndrome scale, PANSS).

Results

Practicability and change sensitivity of the PQRS were found to be sufficient. Significant correlations with independently rated illness insight and medication compliance indicated a construct validity of the scale. Higher age, female sex and less pronounced psychopathological symptoms (PANSS) were associated with better participation behavior. Even patients with clearly impaired participation behavior profited from psychoeducation in that they were able to catch up with the delay with regard to illness knowledge. However, the PQRS was not a predictor of readmission during the 9-month follow-up period or of psychopathological endpoints.

Conclusions

The PQRS is qualified as a new tool for the standardized assessment of participation behavior in people with schizophrenia attending psychoeducation groups. The scale can be applied in research as well as clinical contexts in order to further improve understanding of how psychoeducation works and how this kind of supplementary therapy could become even more effective.     

Politische und soziale Verantwortung von Psychotherapeuten

Psychotherapists should always continuously remind themselves what role they and/or representatives of their discipline played and still play in various political contexts. Under these aspects the following general categories can be suitable for orientation: 1) general political participation, 2) application of specific psychotherapeutic perspectives for understanding of cultural, social and political processes and 3) development of possible activity perspectives from a psychotherapeutic viewpoint. The psychotherapeutic view of social processes and the possible resulting activity perspectives are a consequence of observation of the interplay between exactly these social processes and their deposition in the individual.     

Psychotherapie und Internet

The Internet plays an important role in healthcare. Approximately two thirds of Internet users search the medium for, e.g. personal questions of health, including aspects of mental health. In countless discussion forums or blogs mentally stressed people discuss their problems and search for contact to other affected individuals but also to professional helpers. In this article an attempt is made to systematize the interface between Internet and psychotherapy in the narrower and broader sense. In particular five topics and problem areas will be dealt with: (1) as information medium Internet delivers an immense number of resources on mental disorders, which raises the problem of quality assurance. (2) As a communication medium it can provide support for therapeutic interventions. Psychological online counseling has now been proven to be effective. (3) Internet alters the traditional therapeutic relationship in one way or another. In particular e-mail communications supplement a face-to-face treatment. (4) Use of the Internet also brings along clinically relevant problems and because of this patients visit psychotherapeutic practices increasingly more often. (5) Internet can be fruitful for psychotherapy research.     

Sexueller Sadismus und Sexualkriminalität

The categorization of sadism has turned out to be a versatile phenomenon, which covers a spectrum from harmless symbolic rituals to extremely violent acts where strong impulses or prolonged fantasies and rituals are involved. As the phenomenon is versatile its causes and appearances vary as well, although so-called BDSM (bondage & discipline & dominance & submission & sadism & masochism) practitioners and persons with severe sadism in a forensic context share only few common preferences. Based on own clinical experiences with sadism in forensic patients the authors support the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) especially the diagnostic disjuncture of sadism and masochism. Sexual sadism appears more frequently in forensic contexts in combination with sadistic, antisocial and borderline personality disorders but rarely with masochism. Masochism is otherwise reported to be more prevalent in patients of general psychiatry, however, combined with depression or dependent personality traits rather than with sadism. Moreover, the authors believe that if use of the diagnostic term sadism is perpetuated the establishment of the proposed new diagnosis “paraphilic coercive disorder” is unnecessary. The diagnostic term is also important for treatment and assessment. Despite the lack of reliable long-term studies with larger samples, it is reasonable to assume that medication, sometimes even anti-androgenic treatment, can be indicated in patients with severe sadism.     

Psychotherapie bei lebensbedrohlich Erkrankten

In den letzten 20 Jahren ist die begleitende psychotherapeutische Behandlung bei körperlich Schwerkranken fester Bestandteil der Tätigkeit von psychosomatischen Konsiliar- und Liaisondiensten im Krankenhaus geworden. Eine Konzeptualisierung dieser Tätigkeit auf psychodynamischer Basis wird beschrieben. Ziele der psychotherapeutischen Interventionen sind die Stabilisierung der Abwehr des Patienten und die Rückgewinnung eines strukturierten Umgangs mit der Krankheit, mit den Behandlern und den nahen Bezugspersonen. Therapiebausteine sind eine narrative Gesprächsstruktur, ein psychodynamisches Verständnis der aktuellen Krankheitssituation auf dem Hintergrund der Lebensgeschichte, aktives Zuhören, Fokusformulierung und systemische Sichtweise. Wichtige Wirkfaktoren sind eine empathische Beziehung, Verbalisierung von belastenden, negativen Gefühlen, Fokussieren auf aktuelle Probleme und Ressourcenorientierung. Probleme entstehen durch negative Gegenübertragung des Psychotherapeuten und ausgeprägte Verleugnungsvorgänge auf Patientenseite. Die Umsetzung erfordert vom Psychotherapeuten kontinuierliche Präsenz und regelmäßige Rücksprachen und Konsultationen mit dem behandelnden Team.     

Qualifizierung und Qualitätskontrolle in der forensischen Psychiatrie – die aktuelle Situation in der Schweiz

The practice of civil expert opinions in Switzerland is in a period of upheaval due to fundamental alterations regarding the legal foundations which were implemented on 1 January 2013. The new civil code displaces the authority to order measures which restrict people’s liberty based on an endangerment to themselves or third parties from a lay institution to a newly created expert committee. Moreover, patient’s rights are greatly enhanced. The subsequent consequences for expert opinion activities are not yet appraisable. The development in the practice of insurance legal expert opinion is influenced by new legal measures which aim at reducing the growing number of new disability retirements most notably due to psychiatric disorders. In contrast to the civil area there are already clearly defined standards for the insurance legal area which were established by the Swiss Society of Psychiatry and Psychotherapy in 2012. The legal foundations as well as the practice of expert opinions in the context of the Swiss civil and insurance law are comparable with the German situation but there are still some important differences related to the content and terminology. This paper outlines the current situation and recent developments in Switzerland as well as pointing out differences in comparison to Germany.